scholarly journals An audit into the monitoring of off-label antipsychotics in primary care

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S213-S213
Author(s):  
Damir Rafi ◽  
Javier Ferreiro-Pisos ◽  
John Millwood Hargrave ◽  
Cristina Losada Pérez
Keyword(s):  
Primary Care ◽  
Side Effects ◽  
Physical Health ◽  
Second Generation ◽  
Health Screening ◽  
Adjunctive Treatment ◽  
Off Label ◽  
Second Generation Antipsychotics ◽  
Audit Standard ◽  
Physical Health Screening

AimsTo ascertain whether patients prescribed second generation antipsychotics for off-label indications are being monitored and screened adequately for physical health side-effects.BackgroundThe prevalence of off-label antipsychotic use has increased significantly over recent decades. Common off-licence uses include dementia, post-traumatic stress disorder, adjunctive treatment for unipolar depression and personality disorders. Recent studies have demonstrated that up to 65% of antipsychotic prescriptions are now off-label. Since the metabolic side-effects of second-generation antipsychotics are well-established, guidelines have emphasised the need for active, routine physical health screening of all individuals taking these drugs. However, there have been few studies or reviews which have specifically investigated screening rates of individuals receiving antipsychotic medications for off-licence indications.MethodAn audit of patients taking second-generation antipsychotics for off-label indications, under the caseload of Neighbourhoods 1, 3 and 4 of Lewisham Assessment & Liaison team, was conducted. After isolating individual patients fulfilling inclusion criteria, patient investigation documents were requested from relevant GP practices. 40 patients were isolated in total, and data were successfully collected in 60% (n = 24). Data were collected via a proforma. This consisted of patient information, indications for antipsychotic use, and each variable to be monitored. The audit standard used was the recommendations of the 12th Maudsley guidelines. Data were then entered into SPSS and analysed.ResultThe most common reasons for off-label antipsychotic prescribing were Emotionally Unstable Personality disorder (42%, n = 10) and depression (29%, n = 7). Findings demonstrated that 54% (n = 13) of patients audited had ‘basic’ blood screening (FBC, U&E, LFTs), however glucose (38%, n = 9), Prolactin (13%, n = 3), and Creatine Kinase (0%, n = 0), and monitoring was less frequent. 0% (n = 0) were completely monitored as per audit standard.ConclusionPrimary care monitoring of off-label antipsychotics is unsatisfactory, with no patients having a complete set of investigations. Reasons for this are unclear at this stage, however based on initial discussion with GP surgeries, may be due to lack of education regarding screening investigations, patients lost between primary and secondary care services, and a lack of clarity regarding responsibility and designated roles. This audit will be expanded to also include patients from Neighbourhood 2 of the Lewisham Assessment & Liaison team. A more detailed investigation will be conducted into the barriers to physical health screening, such that a targeted intervention can be implanted.

scholarly journals Interventions to increase access to or uptake of physical health screening in people with severe mental illness: a realist review

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e019412 ◽  
Author(s):  
Frédérique Lamontagne-Godwin ◽  
Caroline Burgess ◽  
Sarah Clement ◽  
Melanie Gasston-Hales ◽  
Carolynn Greene ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Quality Improvement ◽  
Physical Health ◽  
Severe Mental Illness ◽  
Effect Size ◽  
Realist Review ◽  
Health Screening ◽  
Feasibility Trial ◽  
Physical Health Screening

ObjectivesTo identify and evaluate interventions aimed at increasing uptake of, or access to, physical health screening by adults with severe mental illness; to examine why interventions might work.DesignRealist review.SettingPrimary, secondary and tertiary care.ResultsA systematic search identified 1448 studies, of which 22 met the inclusion criteria. Studies were from Australia (n=3), Canada (n=1), Hong Kong (n=1), UK (n=11) and USA (n=6). The studies focused on breast cancer screening, infection preventive services and metabolic syndrome (MS) screening by targeting MS-related risk factors. The interventions could be divided into those focusing on (1) health service delivery changes (12 studies), using quality improvement, randomised controlled trial, cluster randomised feasibility trial, retrospective audit, cross-sectional study and satisfaction survey designs and (2) tests of tools designed to facilitate screening (10 studies) using consecutive case series, quality improvement, retrospective evaluation and pre–post audit study designs. All studies reported improved uptake of screening, or that patients had received screening they would not have had without the intervention. No estimation of overall effect size was possible due to heterogeneity in study design and quality. The following factors may contribute to intervention success: staff and stakeholder involvement in screening, staff flexibility when taking physical measurements (eg, using adapted equipment), strong links with primary care and having a pharmacist on the ward.ConclusionsA range of interventions may be effective, but better quality research is needed to determine any effect size. Researchers should consider how interventions may work when designing and testing them in order to target better the specific needs of this population in the most appropriate setting. Behaviour-change interventions to reduce identified barriers of patient and health professional resistance to screening this population are required. Resource constraints, clarity over professional roles and better coordination with primary care need to be addressed.

scholarly journals Off-label prescribing of quetiapine in south locality crisis teams

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S87-S87
Author(s):  
Mamta Kumari ◽  
Arun Kumar Gupta ◽  
Peter Clarke
Keyword(s):  
Side Effects ◽  
Physical Health ◽  
Health Monitoring ◽  
Treatment Options ◽  
General Medical Council ◽  
Evidence Base ◽  
Medical Council ◽  
Team Members ◽  
Off Label ◽  
Psychotropic Medicines

AimsThe audit was carried out to determine the frequency of off label prescribing of quetiapine and compliance with standards within Trust Policy (UHM PGN 02 PPT PGN 08) – Physical Health Monitoring of Patients Prescribed Antipsychotics and other Psychotropic Medicines, NICE CG178, General Medical Council Ethical Standards and Royal College of Psychiatrists – College Report CR210.The main objectives of the audit were to determine if:Patients have been appropriately informed of off-label status and consent recorded.Alternative licensed treatment first used/ruled out.Appropriate communication on transfer of care.Appropriate physical health monitoring completed.BackgroundQuetiapine is associated with various physical side effects. Patients should be fully informed of the expected risks and benefits of treatment, and the limited evidence base for off-label prescribing.There are additional issues around the transfer of prescribing to primary care.MethodThe sample consisted of 50 consecutive patients selected from the crisis team caseload in the month of December 2018.Data reviewed in this audit were taken from six months period.Records audited were obtained from RiO (electronic records) and prescription charts.Data collection was started in January 2019 and completed in March 2019The audit tool was a dichotomous scale questionnaire based on NICE guidelines.Result4 patients from the sample (8%) were prescribed off-label quetiapine.100% had physical health monitoring completed as per Trust policy.100% off-label indication been clearly documented in notes.100% Consent to treatment was documented.100% had medication reviewed in the previous 6 months.75% had licensed medication used or ruled out before considering off-label quetiapine use25% risks/benefits of treatment were documented as part of a patient discussion.25% had documented evidence that alternative treatment options were discussed.25% had documented evidence of Community consultant/GP consent/agreement was obtained before transfer of prescribing75% had a documented plan for review of quetiapine for treatment efficacy and side effects50% had a documented plan in place for ongoing physical health monitoringConclusionSuggested a wider audit may be required with greater patient numbers and which specifically filters for patients prescribed quetiapine.Audit result has been shared with Crisis team members, Medicines Optimisation Committee and South Locality Quality Standards Committee in the trust.

Physical health screening for patients with severe mental illness

2016 ◽  
Vol 20 (1) ◽  
pp. 21-25
Author(s):  
Tonsha Emerson ◽  
Kimberly Williams ◽  
Maxie Gordon
Keyword(s):  
Mental Illness ◽  
Physical Health ◽  
Severe Mental Illness ◽  
Health Screening ◽  
Physical Health Screening

Use of Administrative Data to Identify Off-Label Use of Second-Generation Antipsychotics in a Medicaid Population

2013 ◽  
Vol 64 (12) ◽  
pp. 1236-1242 ◽  
Author(s):  
Daniel M. Hartung ◽  
Luke Middleton ◽  
Bentson H. McFarland ◽  
Dean G. Haxby ◽  
Marian S. McDonagh ◽  
...  
Keyword(s):  
Administrative Data ◽  
Second Generation ◽  
Off Label Use ◽  
Off Label ◽  
Second Generation Antipsychotics ◽  
Medicaid Population ◽  
Label Use

P.3.02 Metabolic side effects with second generation antipsychotics in antipsychotic-naive adolescents

2007 ◽  
Vol 17 ◽  
pp. S71
Author(s):  
D. Fraguas ◽  
P. Laita ◽  
M. Parellada ◽  
D. Moreno ◽  
A. Cifuentes ◽  
...  
Keyword(s):  
Side Effects ◽  
Second Generation ◽  
Metabolic Side Effects ◽  
Second Generation Antipsychotics

Diet and cardiometabolic side effects in children treated with second-generation antipsychotics

2018 ◽  
Vol 23 ◽  
pp. 205-211 ◽  
Author(s):  
Mikaela K. Barker ◽  
Carly M. Sable ◽  
Sarah E. Montgomery ◽  
Lorrie Chow ◽  
Timothy J. Green ◽  
...  
Keyword(s):  
Side Effects ◽  
Second Generation ◽  
Second Generation Antipsychotics
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