Bridging Community Mental Health and Primary Care to Improve Medication Monitoring and Outcomes for Patients With Mental Illness Taking Second-Generation Antipsychotics—Phase 2: Quality Improvement Initiative Over 15 Months

Mark E. Schneiderhan, PharmD, BCPP; Carolyn O’Donnell, PharmD; Sarah K. Jackson, PharmD; Danielle A. MacDonald, PharmD, BCACP; Ann M. Yapel, PharmD, BCACP; Colleen M. Renier, BS; Jennifer Nelson Albee, MSW, LICSW; Keri D. Hager, PharmD, BCACP

Prim Care Companion CNS Disord. 2023;25(3):22m03432

ABSTRACT

Objective: To evaluate the effectiveness of a quality improvement (QI) initiative to improve family medicine residents’ metabolic monitoring of second-generation antipsychotics (SGAs) for patients comanaged across nonintegrated community mental health and family medicine clinics.

Methods: Patients were aged ≥ 18 years seen by family medicine residents and prescribed at least 1 SGA (N = 175). Preparative and scheduled QI interventions were nonblinded and included collaboration across organizations, education, and monthly interprofessional care conferences. The QI outcome included evaluation of pre-post metabolic monitoring laboratory data over the 15-month study period. A subset of patients (n = 26) was reviewed at least once at monthly interprofessional care conferences. Patients were stratified by diagnosis of diabetes (n = 45) and no diabetes (n = 130) at baseline. Analyses of the QI intervention outcomes were framed by the time period of monthly care conferences (January 31, 2019–April 30, 2020) and compared to baseline (the historical time period) (October 31, 2017–January 29, 2019).

Results: Improved adherence in glycated hemoglobin (HbA_1c) (P = .042) and lipid (P < .001) monitoring per guidelines from baseline to follow-up was seen in the total patient population (N = 175). Patients without diabetes (n = 130) had significant improvement (P = .001) in HbA_1c monitoring from baseline to follow-up. The subgroup of patient cases that were discussed at a care conference showed no significant improvement in HbA_1c or lipid monitoring.

Conclusion: Preparative and scheduled QI interventions provided family medicine residents powerful reminders of the SGA monitoring guidelines that improved the metabolic monitoring behaviors for all patients on SGAs.

Prim Care Companion CNS Disord. 2023;25(3):22m03432

Author affiliations are listed at the end of this article.

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