scholarly journals Cardiovascular risk screening of patients with serious mental illness or use of antipsychotics in family practice.

2020 ◽  
Author(s):  
Kirsti Marieke Jakobs ◽  
Anne Posthuma ◽  
Wim JC de Grauw ◽  
Bianca WM Schalk ◽  
Reinier P Akkermans ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Mental Illness ◽  
Cardiovascular Risk ◽  
Family Practice ◽  
Serious Mental Illness ◽  
Mental Healthcare ◽  
Screening Rate ◽  
Risk Screening ◽  
Family Practices ◽  
Patients With Diabetes

Abstract Background: Patients with serious mental illness (SMI) and patients on antipsychotics (AP) have an elevated risk for cardiovascular diseases. In the Netherlands, the mental healthcare for these patients is increasingly taken care of by family practitioners (FP) as a result of a shift from secondary to primary care. Therefore, it is essential to increase our knowledge regarding the characteristics of this patient group and the (somatic) care provided by their FPs. The aim was to examine the rate of cardiovascular risk screening in patients with SMI or the use of AP in family practice.Methods: We performed a retrospective cohort study of 151.238 patients listed in 24 family practices in the Netherlands.From electronic medical records we extracted data concerning diagnoses, measurement values of CVR factors, medication and frequency of visits over a 2 year period. Primary outcome was the rate of patients who were screened for CVR factors. We compared three groups: patients with SMI/AP without diabetes or CVD (SMI/AP-only), patients with SMI/AP and diabetes mellitus (SMI/AP+DM), patients with SMI/AP and a history of cardiovascular disease (SMI/AP+CVD). We explored factors associated with adequate screening using multilevel logistic regression.Results: We identified 1705 patients with SMI/AP, 834 with a SMI diagnosis, 1150 using AP. The screening rate for CVR in the SMI/AP-only group (n=1383) was adequate in 8.5%. Screening was higher in the SMI/AP-+DM (n=206, 68.4% adequate, OR 24.6 (95%CI, 17.3-35.1) and SMI/AP+CVD (n=116, 26.7% adequate, OR 4.2 (95%CI, 2.7-6.6). A high frequency of visits, age, the use of AP and a diagnosis of COPD were associated with a higher screening rate. In addition we also examined differences between patients with SMI and patients using AP without SMI.Conclusion: CVR screening in patients with SMI/AP is performed poorly in Dutch family practices. Acceptable screening rates were found only among SMI/AP patients with diabetes mellitus as comorbidity. The finding of a large group of AP users without a SMI diagnosis may indicate that FPs often prescribe AP off-label, lack information about the diagnosis, or use the wrong code.

scholarly journals Cardiovascular risk screening of patients with serious mental illness or use of antipsychotics in family practice.

2020 ◽  
Author(s):  
Kirsti Marieke Jakobs ◽  
Anne Posthuma ◽  
Wim JC de Grauw ◽  
Bianca WM Schalk ◽  
Reinier P Akkermans ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Mental Illness ◽  
Cardiovascular Risk ◽  
Family Practice ◽  
Serious Mental Illness ◽  
Mental Healthcare ◽  
Screening Rate ◽  
Risk Screening ◽  
Family Practices ◽  
Patients With Diabetes

Abstract Background Patients with serious mental illness (SMI) and patients on antipsychotics (AP) have an elevated risk for cardiovascular diseases. In the Netherlands, the mental healthcare for these patients is increasingly taken care of by family practitioners (FP) as a result of a shift from secondary to primary care. Therefore, it is essential to increase our knowledge regarding the characteristics of this patient group and the (somatic) care provided by their FPs. The aim was to examine the rate of cardiovascular risk screening in patients with SMI or the use of AP in family practice.Methods We performed a retrospective cohort study of 151.238 patients listed in 24 family practices in the Netherlands.From electronic medical records we extracted data concerning diagnoses, measurement values of CVR factors, medication and frequency of visits over a 2 year period. Primary outcome was the rate of patients who were screened for CVR factors. We compared three groups: patients with SMI/AP without diabetes or CVD (SMI/AP-only), patients with SMI/AP and diabetes mellitus (SMI/AP+DM), patients with SMI/AP and a history of cardiovascular disease (SMI/AP+CVD). We explored factors associated with adequate screening using multilevel logistic regression.Results We identified 1705 patients with SMI/AP, 834 with a SMI diagnosis, 1150 using AP. The screening rate for CVR in the SMI/AP-only group (n=1383) was adequate in 8.5%. Screening was higher in the SMI/AP-+DM (n=206, 68.4% adequate, OR 24.6 (95%CI, 17.3-35.1) and SMI/AP+CVD (n=116, 26.7% adequate, OR 4.2 (95%CI, 2.7-6.6). A high frequency of visits, age, the use of AP and a diagnosis of COPD were associated with a higher screening rate. In addition we also examined differences between patients with SMI and patients using AP without SMI.Conclusion CVR screening in patients with SMI/AP is performed poorly in Dutch family practices. Acceptable screening rates were found only among SMI/AP patients with diabetes mellitus as comorbidity. The finding of a large group of AP users without a SMI diagnosis may indicate that FPs often prescribe AP off-label, lack information about the diagnosis, or use the wrong code.

scholarly journals Cardiovascular risk screening of patients with serious mental illness or using antipsychotics in family practice.

2020 ◽  
Author(s):  
Kirsti Marieke Jakobs ◽  
Anne Posthuma ◽  
Wim JC de Grauw ◽  
Bianca WM Schalk ◽  
Reinier P Akkermans ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Mental Illness ◽  
Cardiovascular Risk ◽  
The Netherlands ◽  
Family Practice ◽  
Serious Mental Illness ◽  
Mental Healthcare ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Family Practices

Abstract Background Patients with a serious mental illness (SMI) and those using antipsychotics (AP) have an elevated risk for cardiovascular disease (CVD). In the Netherlands, the mental healthcare for these patients is increasingly provided by family practitioners (FPs), following a shift from secondary to primary care. It is therefore essential to better understand the characteristics of this patient group and the (somatic) care provided by their FPs. The aim of this study was to examine the rate of cardiovascular risk (CVR) screening in patients with SMI or those using APs in family practice. Methods We performed a retrospective cohort study of 151,238 patients registered with 24 family practices in the Netherlands. From electronic medical records, we extracted data concerning diagnoses, the measurement of CVR factors, medication, and the frequency of visits over a two-year year period. The primary outcome was the proportion of patients who were screened for CVR factors. We compared three groups: patients with SMI or using AP without diabetes or CVD (SMI/AP only), patients with SMI or using AP and diabetes mellitus (SMI/AP+DM), and patients with SMI or using AP and a history of CVD (SMI/AP+CVD). We explored the factors associated with adequate screening using a multilevel logistic regression. Results We identified 1705 patients with SMI or using AP, 834 of whom had a SMI diagnosis and 1150 of whom used AP. CVR was adequately screened in 8.5% of the SMI/AP-only group (117 of 1383 patients). Screening was much more commonly performed in the SMI/AP+DM (n=206, 68.4% adequate) and SMI/AP+CVD (n=116, 26.7% adequate) groups. (ORs for moderate and adequate screening 21.8 (95%CI, 15.4-30.8) and 4.3 (95%CI, 2.8-6.6) respectively). A high frequency of FP visits, age, the use of AP, and a diagnosis of chronic obstructive pulmonary disease were associated with a higher screening rate. In addition, we examined the differences between patients with SMI and patients using AP in the absence of a SMI. ConclusionsCVR screening in patients with SMI or using AP is often inadequate or lacking in Dutch family practices. Acceptable screening rates were found only among SMI/AP patients with diabetes mellitus as a comorbidity.

scholarly journals Cardiovascular risk screening of patients with serious mental illness or use of antipsychotics in family practice

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Kirsti M. Jakobs ◽  
Anne Posthuma ◽  
Wim J. C. de Grauw ◽  
Bianca W. M. Schalk ◽  
Reinier P. Akkermans ◽  
...  
Keyword(s):  
Mental Illness ◽  
Cardiovascular Risk ◽  
Family Practice ◽  
Serious Mental Illness ◽  
Risk Screening

Diabetes-induced Alterations in HDL Subfractions Distribution

2020 ◽  
Vol 26 (27) ◽  
pp. 3341-3348 ◽  
Author(s):  
Marek Femlak ◽  
Anna Gluba-Brzozka ◽  
Beata Franczyk ◽  
Jacek Rysz
Keyword(s):  
Diabetes Mellitus ◽  
Cardiovascular Risk ◽  
Public Health Problem ◽  
Statin Treatment ◽  
Oxidative Modification ◽  
Control Group ◽  
Newly Diagnosed ◽  
Hdl Subfractions ◽  
Patients With Diabetes ◽  
Healthy Control

Introduction: Diabetes mellitus (DM) due to its increasing prevalence and associated morbidity and mortality has become a serious public health problem. In DM, HDL may lose its beneficial features and become proatherogenic due to its altered biological activity thus increasing cardiovascular risk. The aim of this study was to assess the influence of the presence of diabetes mellitus type 2 and its duration on the distribution of HDL subfractions. Moreover, the effect of statin treatment on HDL subfraction share was analysed in this study. Methods: The study group consisted of 50 patients with newly diagnosed DM and 50 persons with DM for longer than 10 years while the control group consisted of 50 healthy volunteers. HDL subfractions were analysed with the use of Lipoprint. Results: We demonstrated progressive worsening of heart functioning and impairment of its structure in the course of diabetes mellitus. Moreover, we observed that HDL-6 subfraction and intermediate HDL fraction are lowest in the group with advanced DMt2 compared to the group with newly diagnosed DM and a healthy control group. Finally, the results of our study indicated the effect of statin treatment on HDL subfractions that seems not to be advantageous. Conclusion: It seems that in patients with diabetes mellitus compromised antiatherogenic properties of HDL, as a result of oxidative modification and glycation of the HDL protein as well as the transformation of the HDL proteome into a proinflammatory protein, increase cardiovascular risk.

scholarly journals Creating a ‘reverse’ integrated primary and mental healthcare clinic for those with serious mental illness

2015 ◽  
Vol 17 (05) ◽  
pp. 421-427 ◽  
Author(s):  
Alexandros Maragakis ◽  
Ragavan Siddharthan ◽  
Jill RachBeisel ◽  
Cassandra Snipes
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Quality Of Care ◽  
Serious Mental Illness ◽  
Mental Healthcare ◽  
Policy Reforms ◽  
Mental Health Settings ◽  
Primary Care Practitioners

Individuals with serious mental illness (SMI) are more likely to experience preventable medical health issues, such as diabetes, hyperlipidemia, obesity, and cardiovascular disease, than the general population. To further compound this issue, these individuals are less likely to seek preventative medical care. These factors result in higher usage of expensive emergency care, lower quality of care, and lower life expectancy. This manuscript presents literature that examines the health disparities this population experiences, and barriers to accessing primary care. Through the identification of these barriers, we recommend that the field of family medicine work in collaboration with the field of mental health to implement ‘reverse’ integrated care (RIC) systems, and provide primary care services in the mental health settings. By embedding primary care practitioners in mental health settings, where individuals with SMI are more likely to present for treatment, this population may receive treatment for somatic care by experts. This not only would improve the quality of care received by patients, but would also remove the burden of managing complex somatic care from providers trained in mental health. The rationale for this RIC system, as well as training and policy reforms, are discussed.

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