Atypical Antipsychotics Monitoring Results
Magellan is grateful for the input we receive from our providers, especially when member safety is involved. Last year, you had questions regarding atypical, or second-generation, antipsychotics (SGAs) monitoring. The Southwest and Michigan Care Management Centers responded by implementing a quality improvement activity and auditing tool to monitor members taking SGAs.
A consensus guideline promulgated by the American Diabetes Association, American Psychiatric Association, and the American Association of Clinical Endocrinologists recommends that certain aspects of patient health and family history be assessed at baseline and/or follow-up visits. Therefore, our monitoring tool incorporated the measurement of the following factors:
- Personal and family history of obesity, diabetes, dyslipidemia, hypertension, and cardiovascular disease
- Weight and height (or BMI)
- Blood pressure
- Fasting plasma glucose
- Fasting lipid profile.
A summary of Magellan’s 2008 baseline data for monitoring members on SGA medications is included below.
Category |
Results (% Monitored) |
|---|---|
Members’ personal history |
|
Members’ family history |
|
Weight and height (or BMI) |
20% |
Blood pressure |
24% |
Fasting plasma glucose |
32% |
Fasting lipid profile |
28% |
These results indicate significant opportunities for improvement by practitioners to monitor the metabolic side effects of SGAs. While second-generation agents have a lower tendency to cause extrapyramidal side effects—such as rigidity, tremor, and akathisia—than do the first-generation antipsychotics, they do have their own set of side effects that must be monitored. These side effects can include weight gain, Type II diabetes, hyperlipidemia, agranulocytosis, and prolactin elevation.
Please note
- We strongly encourage all psychiatrists to monitor the metabolic side-effects for all patients on SGAs as recommended by the consensus guidelines.
- We will monitor network performance to the consensus guideline for your new patients treated with SGAs later this year.
To assist you in monitoring your patients, Magellan has developed the following materials:
- A tip sheet pertaining to second-generation antipsychotic medications. The tip sheet briefly describes benefits, issues, and side effects of atypical anti-psychotic medications.
- An informational sheet for member use, “Medication Safety and Second-Generation Antipsychotics.”