Transcript Performance Improvement Project Powerpoint

Increase the Proportion of Metabolic
Syndrome Screening In Adults with Severe
Mental Illness receiving "atypical” second
generation antipsychotics
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Study Indicator: The percentage of consumers who are prescribed
“atypical” second generation antipsychotic medication and are also
monitored for metabolic syndrome by having at least one of the
Adult Treatment Panel (ATP) III measures completed during the
measurement period.
Purpose: Identify consumers at risk of developing Diabetes and
Cardiovascular disease by monitoring for Metabolic Syndrome when
prescribing “atypical” second generation antipsychotic medications.
By identifying these consumers, MCCMH staff will initiate and
conduct activities conducive to prevent, minimize, and manage risks
associated with “atypical” second generation antipsychotic use in
consumers with severe mental illness.
Goal: Improve process and outcomes of health care delivery by
early identification of indicators of metabolic risk which can lead to
Diabetes
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“Atypical” Second Generation Antipsychotic
Medications: Abilify (Aripiprazole), Clozaril
(Clozapine), Geodon (Ziprasidone), Invega
(Paliperidone), Risperdal (Risperidone),
Risperdal Consta, Seroquel (Quetiapine) and
Zypreza (Olanzapine)
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Adults with serious mental illness, commonly
treated with second-generation antipsychotic
(SGA) drugs, have up to two-times-greater
prevalence of type 2 diabetes, dyslipidemia,
hypertension, and obesity.
Cardiovascular disease is the leading
contributor to mortality for adults with serious
mental illness resulting in a decades less life
expectancy than the general population
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Increased risk for premature cardiovascular
mortality has been attributed to lower
socioeconomic status, physical inactivity and
poor dietary choices, obesity, greater smoking
and substance abuse, adverse medication
effects, and underutilization of primary and
secondary prevention.
Unfortunately, diabetes and cardiovascular risk
is often under recognized and undertreated in
patients with mental illness.
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Metabolic Syndrome is a group of risk factors
present in a single individual that promote the
development of coronary artery disease,
stroke, and Type 2 Diabetes.
The symptoms of Metabolic Syndrome include:
unhealthy cholesterol levels, high blood
pressure, high blood sugar, and excess belly fat
(waist circumference over 35" for women and
40" for men).
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Those with Metabolic Syndrome are at risk of
serious health problems including heart attack,
stroke and Diabetes. In fact, the chance for
Diabetes can be as much as five times higher
than in the general public.
A person is said to have Metabolic Syndrome
when elevations of the above measurements are
present along with the increased waist size.
Thus, it's the combination of the four
criterions that leads to the most risk.
ATP III Criteria for Clinical Identification of Metabolic Syndrome
any 3: Per recommendation from the Mount Sinai Conference:
measurement of fasting plasma glucose level is preferred but
measurement of Hemoglobin A1C is acceptable if a fasting plasma
glucose test is not feasible
Risk Factor
Abdominal Obesity
 Men
 Woman
Indicator
Waist Circumference
 > 102 cm (>40 inches)
 > 88 cm (>35 inches)
Fasting Triglycerides
Fasting HDL Cholesterol
 Men
 Woman
>=150 mg/d1
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<40 mg/dl
<50 mg/dl
Fasting Glucose( Hgb A1C can also be done)
>= 110 mg/dl or medication treatment
Blood Pressure
>= 130/85 mm Hg or medication treatment
Measure
Personal/family history
Baseline 4-weeks 8-weeks 12-weeks Annually
X
X
Weight (Body Mass
Index-BMI)
X
Waist circumference
X
Blood pressure
X
X
X
Fasting blood glucose
X
X
X
Fasting lipid profile
X
X
X
X
X
X
X
X
Measure
Baseline 4-weeks 8-weeks
12weeks
Quarterly Annually
Medical and Family
history including
X
X
CVD
Weight (Body Mass
Index-BMI)
X
Waist circumference
X
Blood pressure
X
Hemoglobin A1C
X
Random blood
glucose
Non-fasting Total
Cholesterol and HDL
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Generic
(Trade Name)
Aripiprazole
(Abilify)
Clozapine
(Clozaril)
Olanzapine
(Zyprexa)
Quetiapine
(Seroquel)
Risperidone
(Risperdal)
Ziprasidone
(Geodon)
Weight Gain
Dyslipidemia
Hyperglycemia
Low
Low
Low
Metabolic
Syndrome
Low
High
High
High
High
High
High
High
High
Moderate
High
Moderate
Moderate
Mild-Moderate Mild
Mild
Mild
Low
Low
Low
Low
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Case Managers need to instruct consumers on
medication risks including information on
Metabolic Syndrome as well as information on
the particular medication that they are on.
Consumer Information is posted on the share
point site and information on the medications
can be found in FOCUS under the Medical Tab
patient education heading. You can search
under either Medication or Diagnoses.
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Physicians need to:
(1)Ensure the appropriate psychiatric diagnosis
is made.
(2) Consider target symptoms, approved
indications, and degree of functional
impairment before initiating treatment.
(3) Monitor all patients on an “atypical” secondgeneration antipsychotic according to approved
protocol.
(4) Encourage preventive lifestyle practices.
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Physicians need to educate themselves on
Metabolic Syndrome and the necessity of
monitoring for its potential occurrence.
Physicians need to educate the consumers and
their families/caregivers on the medications
they are taking as well as the risk of metabolic
syndrome.
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Physicians need to monitor consumers using the
ADA/APA Screening Guidelines and if consumers
exceed the cut-off, they need to contact the
consumer’s PCP to coordinate an appropriate
course of treatment.
Staff within the agency: Case Managers, Nurses,
Physicians, etc. need to make sure that consumers
have their blood work as well as weight-BMI, BP,
and waist circumference measured at the time the
medication is initiated and throughout the course
of time that the consumer is on the medication.
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Consider working with the consumer on health
goals related to the medication and its side
effects. For example: encouraging preventive
lifestyle practices such as improving diet and
exercise habits; making sure that blood work is
completed on monitoring schedule; referring to
dietitian, weight loss program, etc.
If you have any questions or
suggestions, please feel free to
contact me at 586-948-6169 or
[email protected]