UNIVERSITY OF ILLINOIS AT CHICAGO
Department of Psychiatry
Fifth Annual Research Forum – Extravaganza 2014
POSTER TITLE
Resident Run Clinic to Monitor Metabolic Risk in Patients with Psychosis
DISEASE/KEY
WORDS:
Psychotic Disorders, Metabolic Monitoring, Quality Improvement Milestones
AUTHORS:
Christina Floreani MD, Rafael Lopez-Sanchez MD, Katrina Burns, Mallory Feng MD,
Trixie Lipke MD, Alex Yuen MD, Matt Sienna PharmD Candidate, Shiyun Kim PharmD
MENTEE
CATEGORY:
Residents
BACKGROUND:
Individuals with serious mental illness (SMI) have rates of mortality two to three
times greater than the general population. On average, people with a SMI die 25
years earlier than the general population, with 60% due to preventable and treatable
medical conditions, including metabolic syndrome, diabetes, high blood pressure,
and cardiovascular disease. These trends result from the effects of anti-psychotic
medications, poor diet and sedentary lifestyles, high rates of smoking, and lack of
early detection and preventive care. Elevated morbidity and mortality is largely due
to preventable conditions such as obesity, metabolic syndrome, diabetes,
hypercholesterolemia, and hypertension. This suggests a failure in detection, early
intervention, treatment, and long-term chronic illness management.
RESEARCH MENTOR:
Rajiv Sharma MD; Robert
Marvin MD, Sean Conrin
MD, Aneet Ahluwalia, MD.
In order to address this issue in clinical practice the Psychosis Treatment Program
(PTP) designed a Quality Improvement initiative that supports ongoing metabolic
screening in keeping with ADA/APA consensus guidelines.
METHODS:
In keeping with the Plan Do Check Act (PDCA) Quality Improvement model of process
change, the Psychosis Treatment Program (PTP) has established a Metabolic
Monitoring Clinic (MMC). During the “Plan Phase”, PTP engaged in multidisciplinary
discussion exploring compliance barriers to ADA/APA Consensus Guidelines to
identify perceived barriers. Methods were identified to obtain: A.) Baseline Primary
Care Physician (PCP) status and demographic data; B.) Personal and family history of
pre-existing illness such as diabetes, hypertension, and hypercholesterolemia; C.)
Metabolic indices such as vital signs, height, weight, BMI, waist and hip
circumference, fasting glucose, fasting lipid profile, and AIMS; D.) Modifiable Risk
Factors such as smoking, alcohol use, and level of activity and; E.) Interventions.
During the “Do Phase” baseline data of PCP status and metabolic indices were
collected, and appropriate interventions were implemented.
RESULTS:
The Metabolic Monitoring Clinic administered a needs assessment to patients seen in
the PTP medication clinic. The services needs assessment included questions
pertaining to current Primary Care Physician (PCP) involvement, location of PCP, and
interest in reverse co-location of a PCP available during clinic hours. Forty-one
UNIVERSITY OF ILLINOIS AT CHICAGO
Department of Psychiatry
percent of responders (n=100) reported they had not been evaluated by a PCP within
the last year and 54% expressed interest in seeing a PCP during their psychiatric
medication clinic appointment. The retrospective chart review of baseline metabolic
indices was also conducted and data reviewed in clinic. Processes were identified to
integrate metabolic monitoring as part of routine clinical care.
CONCLUSIONS:
In addition to other health risks, people with SMI are more vulnerable to the
development of metabolic and cardiovascular abnormalities, including obesity,
hypertension, diabetes, dyslipidemia, and hyperuricemia. In order to reduce health
risks associated with metabolic syndrome the Psychosis Treatment Program,
Metabolic Monitoring Clinic has established a monthly reverse co-location service
provided by Internal Medicine and an ongoing process to monitor metabolic indices.