Educating Clinicians about Potential risk of Metabolic Syndrome among Patients on antipsychotics

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Educating Clinicians about Potential risk of Metabolic Syndrome among Patients on antipsychotics

Metabolic Syndrome (MetS) is a combination of obesity (abdominal), elevated triglycerides, high blood pressure, hyperglycemia, and low high-density lipoprotein cholesterol (Penninx & Lange, 2018). MetS was coined to assist clinicians in identifying patients at risk for cardiovascular diseases (CVD) and Type 2 Diabetes Mellitus (T2DM). The author seeks to develop a quality improvement (QI) project using the Institute for Healthcare Improvement’s (IHI) Model for Improvement to assist mental health providers in detecting patients at-risk for MetS.

Clinical Background

 Psychiatric and mental health patients have a higher risk of premature death. The current epidemiology studies suggest that the life expectancy rate of seriously mentally ill (SMI) patients is seven to 20 years lower compared to the general population (Penninx & Lange, 2018). The low life expectancy rate among psychiatric patients is due to numerous factors of which physical comorbidities play a vital role. MetS makes up most of the medical comorbidities present among mental health patients, and it’s also 58% higher in SMI patients than in the general population (Penninx & Lange, 2018). Patients diagnosed with schizophrenia are more likely to die from cardiovascular disease than those in the general population (Gautam & Meena, 2011). Mental health patients suffer from comorbid medical conditions that often go untreated or overlooked by mental health providers (McBain, Lamotagne-Godwin, Haddad, Simpson, Chap, Jones & Mulligan, 2018). McBain et al. (2018) found that although T2DM, a component of MetS, is prevalent among mental health patients, the management of T2DM at psychiatric inpatient hospitals remains peripheral.

Convincing evidence shows that antipsychotic medications have an established risk of MetS (Bozymski, Whitten, Blair, Overly, & Ott, 2017). Based on this evidence, there should be periodic clinical assessment and medication evaluation for individuals initiated on antipsychotics (Toalson, Ahmed, Hardy, & Kabinoff, 2004). Furthermore, due to the immense burden of CVD and T2DM, patients who suffer MetS incur a heft healthcare cost annually (Nichols & Moler, 2011). Identifying potential at-risk patients will not only reduce healthcare cost but significantly, treat MetS and halt the progression of CVDs and T2DM (Bozymski et al., 2017). It is, therefore, paramount to educate mental health providers about the prevalence of MetS in patients on antipsychotic medications. The available literature shows that improving staff’s knowledge on the use of practice guidelines for monitoring MetS should increase the adherence for MetS screening, and ultimately produce a positive patient outcome (Omile, 2019; Kioko, Williams, & Newhouse, 2016).

Local Problem

 Arizona has a population of about 6.7 million. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 4.6 percent of adults in Arizona suffer from severe mental illness such as schizophrenia, major depressive disorder, and bipolar disorder. Despite the efforts of the state-run program like Arizona Health Care Cost Containment System (AHCCCS) and Regional Behavioral Health Authorities (RBHAs), only 40.3% of adults with mental illness in Arizona receive treatment (Mental, 2019). A study conducted by Mental Health America ranks Arizona 36 out of 50 regarding access to mental health services (Mental, 2019).  Even though the state of Arizona ranks low when it comes to access to mental health services, the treatment of MetS is projected to increase astronomically.

In 2009, the Arizona State University (ASU) and the Mayo Clinic joined forces to combat MetS in Arizona. The director of the partnership program and a professor of the Center for Metabolic Biology at ASU, Lawrence Mandarino Ph.D., affirmed that MetS accounts for an increasing proportion of the health care burden and cost in Arizona. The cost of treating the individual components of MetS will increase tremendously in the next few decades (Luckstein, 2009). The author plans to implement a QI project in an outpatient health center in southern Arizona. Although the center sees on the average 20 patients per day, there is no standardized protocols for monitoring MetS risk in patients taking antipsychotics.

Project Question

The project question to ground this QI is: Will the development and evaluation of an educational module have the potential to increase cli

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