“Let’s get physical” – establishment of a regional metabolic monitoring clinic’s impact on screening

Objective: The Royal Australian and New Zealand College of Psychiatrist (RANZCP) Clinical Practice Guideline for Schizophrenia and Related Disorders highlights the importance of regular monitoring of physical health in those with psychotic illnesses. This audit is a retrospective review of current practice at a regional community mental health team* with regards to identifying patients on anti-psychotic medications and monitoring those at risk of metabolic syndrome in comparison to the standards set by the RANZCP Guidelines for metabolic monitoring. It considers whether implementation of a dedicated metabolic monitoring clinic could improve monitoring in a regional psychiatric outpatient clinic. Settings: This audit was based on data collected from a single community mental health team which covers low socioeconomic suburban areas as well as a small aboriginal community. Patients seen in the outpatient clinic on anti-psychotic medications had a range of diagnoses including psychotic depression, chronic schizophrenia, and schizoaffective disorder. Subjects and Methods: Patients from a single regional adult community mental health clinic ranging in age from 18-70 years old and on anti-psychotic medications were included in the study. A pre-intervention audit of monitoring of metabolic syndrome was performed on all such patients. A dedicated metabolic monitoring clinic was set up, including targeted improvement strategies to make monitoring more accessible in a clinic-based setting and post-intervention audit was then undertaken at 6-monthly intervals. Results: Implementing a metabolic monitoring clinic 3 days a week was associated with a significant improvement of 33% in rates of metabolic monitoring. Conclusion: The metabolic monitoring clinic led to improved screening and monitoring of metabolic syndrome in patients on psychotropic medications but standards remained lower than recommended. Ongoing psycho-education and incorporation throughout the service would likely facilitate extrapolation of these results over time. Further research into focussed strategies is required to improving monitoring to guideline concordant rates.