Saulo Castel (Sunnybrook Health Sciences Centre, Ontario Shores, University of Toronto); Jay Moss (Sunnybrook Health Sciences Centre, University of Toronto); Amy Cheung (Sunnybrook Health Sciences Centre, University of Toronto); Benjamin Goldstein (Sunnybrook Health Sciences Centre, University of Toronto); Ayal Schaffer (Sunnybrook Health Sciences Centre, University of Toronto); Krista Lanctot (Sunnybrook Health Sciences Centre, University of Toronto); Sonia Dyett (Sunnybrook Health Sciences Centre); Shing Cho (Sunnybrook Health Sciences Centre)
The use of atypical antipsychotics and/or mood stabilizers requires baseline physical and biochemical assessments and ongoing monitoring to optimize patient safety, however, despite the available guidelines to inform clinical monitoring protocols for patients on these medications, adherence to the guidelines is poor. Through chart audits and a survey of psychiatrists at an academic health science centre (AHSC), we have identified gaps between these guidelines and clinical practice within the Department of Psychiatry. We plan to design and test interventions to enhance implementation of published guidelines with the input of psychiatrists, allied health professionals and patients.
The use of atypical antipsychotics and mood stabilizers requires ongoing monitoring to optimize patient safety and minimize MS. There are guidelines to inform these practices.
We assessed the attitudes, perceived and actual practices on monitoring for MS of a psychiatric service in an AHSC in Toronto, Canada.
A survey of 27 psychiatrists about their attitudes and perceived practices towards the Guidelines of the International Society of Bipolar Disorders was conducted; response rate was 92.6%. We audited 104 charts (35 inpatients, 34 regular outpatients and 35 outpatients of an assertive community treatment team (ACT)) selected sequentially, of clients 20+ years, for monitoring practices.
The psychiatrists rated the recommendations of the guidelines as essential (90%) and believed that they follow them 80% of the time. The chart audit rendered a compliance with the recommendations below 20% for most of them. There were significant differences in compliance between inpatients and outpatients suggesting that different processes may be implicated.
The actual practices fall below what the psychiatrists judged as appropriate and believed they were practicing. The next step, already in course, is to conduct a series of interprofessional focus groups, including patients to (1) identify barriers and facilitators of compliance and (2) to design and test interventions to improve metabolic monitoring. We have already identified some misconceptions about MS, therefore these interprofessional interventions will include education about content of the guidelines and process changes to facilitate behavior change among practitioners.
AFP Innovation Fund