Advocacy for better metabolic monitoring after antipsychotic initiation: based on data from a French health insurance database

ABSTRACT

Background: Nearly 3% of the population is treated by antipsychotic. The aim of this study was to assess the conformity of monitoring with guidelines to prevent Metabolic Syndrome.

Research design and method: The analysis was conducted using SNIIRAM data (2013 to 2017) on a cohort of patients who received at least eight antipsychotic dispensings in the first year. Glucose and lipid testings were recorded according to refunds at initiation [between −3 and 0.5 months], 3 months [between 2 and 4 months], and 12 months [between 11 and 13 months] after, and assuming optimal testing during hospitalization (exclusive of psychiatric unit). Descriptive and comparative analysis, «chi-squared test or Student’s t-test», were performed as well as multivariate analysis with logistic regression.

Results: 18 760 patients were selected, 14 421 were still alive and monitored at the end of the follow up. In the recommended period, only 2.89% of patients had three complete testings and 50.6% one or two complete testings Non-optimal testing was more likely to occur in children and adults (vs elderly), in patients with less than 3 prescribers, and with universal medical coverage.

Conclusion: Monitoring remains dramatically insufficient. New actions involving patients, practitioners, and authorities are warranted.

KEYWORDS:

• Antipsychotics
• metabolic syndrome
• monitoring
• health insurance database

Author contributions

All authors contributed to the design of the study and methodology optimization. SB, CVV, and ML wrote the manuscript. PA, AC, BF, EM were responsible for statistical analysis. SB, ML, OB, and CVV provided expertise on antipsychotic use and monitoring in psychiatry and pharmacology. All authors provided significant contribution during manuscript rereading before publication.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This research received no specific grant from any funding agency, commercial or not-for-profit sectors.