Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education,Manipal, India
Background: Atypical antipsychotics are associated with metabolic adverse effects.
Objectives: i) To explore the perspectives of psychiatric patients and psychiatrists through qualitative study and meta-synthesis ii) Development and piloting of the strategies for metabolic monitoring that targets the practitioners and patients
Methods: Semi-structured interviews were conducted with 29 purposively sampled participants, (n = 20 patients, n = 9 psychiatrists). Participants were encouraged to share their experiences with atypical antipsychotics and metabolic monitoring. Thematic analysis was undertaken by an inductive approach. For the meta-synthesis, a systematic search was conducted through SCOPUS, PubMed, EMBASE, and CINAHL to identify qualitative studies of patients’ and healthcare professionals' perspectives on metabolic monitoring. Themes were synthesized and presented as per the Interpretive data synthesis process (Evans D, 2003). We developed metabolic monitoring offline tool (intervention 1 group) to monitor fasting blood sugar, triglycerides, high- density lipoprotein, blood pressure and waist circumference along with the messages to remind the patients regarding the visit date. Patient information leaflets (intervention 2 group) was developed to make the patients aware regarding the side effects of the medications and its prevention. To check the feasibility of the intervention, randomized controlled trial was conducted. Control group was not provided with any interventions.
Results: From the patients’ perspectives, medication side effects, lack of awareness, inaccessibility of services, lack of interest in monitoring, patient motivation to maintain physical health and financial constraints negatively impacted ongoing care and health outcomes. From psychiatrists’ perspectives, the interplay of patient related factors, and their own experienced barriers such as time constraints, limited hospital resources, role confusion and lack of standardised guidelines negatively impacted their ability to metabolic monitoring. Integrated mental health services as well as strategies for adherence to guidelines on metabolic monitoring were the expectations from the participants on improving the rate of metabolic monitoring. Based on the themes emerged, best two strategies for pilot study were selected. The rate of monitoring for metabolic parameters with the metabolic monitoring offline tool showed better monitoring at baseline (91.7 %) and subsequent visit at 3rd month (75 %) compared to the patient information leaflet group and control group.
Conclusions: Technology based strategies focusing on constant awareness and reminders resulted in a significant improvement in the rate of metabolic monitoring in these patients.
