Atypical Antipsychotics

Questions:

  1. How commonly are atypical anti-psychotics prescribed in the network?
  2. What are the most common diagnoses associated with atypical anti-psychotic prescriptions?
  3. What is the rate of monitoring for metabolic complications for those patients on atypical antipsychotics in the network?
  4. What are the perceptions of primary care practitioners on the indications for atypical antipsychotics?

Description:

Atypical antipsychotics are more commonly prescribed than would be expected, based on the commonly reported statistics for prevalence of schizophrenia (e.g. 1%). The majority of uses of of antipsychotics are likely not for schizophrenia. See this review.

A recent Cochrane Review reviewed use of atypical anti-psychotics in anxiety. They found there was evidence for seroquel. There was insufficient evidence for other atypicals. We would like to see if the rates in BC are high and what the common recorded diagnoses are in patients on atypical antipsychotics.

A review of current practices will be completed within the network. Practice data will be queried to generate answers to questions 1 and 2. Based on the findings from those data, a survey will be developed to address question 3 that will be sent to all participating practices.

 

Example Output

 

Rates of Atypical Antipsychotic Use

A. Prevalence of patients on one of the class of atypical antipsychotics (all ages)

B. Prevalence of patients on one of the class of atypical antipsychotics in the network by gender and age bracket.

 

Common Diagnoses related to use of Atypical Antipsychotics

Rank order list of most common diagnoses found on patient current problem lists who are also on atypical antipsychotics.

(BONUS: break down by gender)

 

Screening for metabolic complications in patients taking atypical antipsychotics

The evidence for screening and management of metabolic syndrome in patients taking atypical antipsychotics is mixed. This actually makes it an excellent educational topic as there is some increasing pressure to routinely screen cholesterol and glucose on patients and this could be a considerable expense to the health system and a burden to the patients.

For development, the reports for the network would be kept very simple:

  • # of patients on  olanzapine  who have had a fasting glucose test in the last year.
  • # of patients on  olanzapine  who have had a fasting cholesterol test in the last year.
We will expand these in the future to include other medications and measurement of frequency of testing. To effectively apply this in an educational setting, individual providers would need to know their own rates and be able to compare these to their local “education network” averages. This would be additional features in the endpoint and this will come out in future iterations.

 

 

Expected Data Requirements:

  • Patient Gender
  • Patient Age
  • Current Problem List
  • Current Medication List
  • Laboratory Results Record (fasting glucose, fasting cholesterol panel).

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