What is the clinical evidence from this study?

Study design: Systematic Review. Population: Severe mental illness prescribed antipsychotic drugs. Intervention: Cardiovascular and metabolic health monitoring and management. Primary outcome: Barriers to monitoring and management.

What does this research mean for the field?

Barriers to monitoring and managing cardiovascular and metabolic health in patients prescribed antipsychotics are multidimensional, involving healthcare system constraints such as fragmented care and role confusion, as well as patient-related factors like disability and lack of knowledge. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

December 1, 2020Open Access

Barriers to monitoring and management of cardiovascular and metabolic health of patients prescribed antipsychotic drugs: a systematic review

Key Result

Barriers to monitoring and managing cardiovascular and metabolic health in patients prescribed antipsychotics are multidimensional, involving healthcare system constraints and patient-related factors.

Study Design

Type

Systematic Review

Structured PICO

Population

Patients aged ≥18 years old using one or more antipsychotics for severe mental illnesses, and health care professionals involved in their care (21 studies included).

Intervention

Monitoring and management of cardiovascular and metabolic side effects associated with antipsychotic medicines

Outcome

Barriers to monitoring and management of cardiovascular co-morbidities

Barriers to monitoring cardiovascular and metabolic health in patients on antipsychotics are multidimensional, highlighting the need for system-level improvements, clearer guidelines, and educational interventions.

Limitations

Some included studies did not recruit patient participants based specifically on their use of antipsychotic drugs
Search was limited to English language due to constraints in time and funding

Abstract

BACKGROUND: The use of atypical antipsychotics which currently form the primary choice pharmacotherapy for several mental health conditions have been linked to cardiovascular and metabolic side effects. This systematic review aimed to investigate the barriers to monitoring and management of cardiovascular co-morbidities in patients prescribed antipsychotic medicines. METHODS: A protocol-led (CRD-42018106002) systematic literature review was conducted by searching Medline, Embase, and PsycINFO databases 2003 until October 2019. Cochrane, Centre for Review and Dissemination (CRD) and PRISMA guidelines were followed. Studies investigating barriers to monitoring and management of cardiovascular co-morbidities in patients prescribed antipsychotic medicines were included. RESULTS: A total of 23 records were included. Key barriers included a) health-care system-related factors such as lack of knowledge and expertise amongst care providers, available resources, confusion around remit and roles, fragmentation of care such as across general practitioners and psychiatrists, and time constraints and b) patient-related factors such as disability resulting from mental health conditions, knowledge and skills of the patients. CONCLUSION: Barriers to monitoring and management of cardiovascular and metabolic health of patients taking antipsychotic medicines are multidimensional. Apart from educational interventions directed to both patients and health-care professionals, the results suggest a need for the improvement of wider system-related factors to improve physical health of patients prescribed antipsychotic medicines. Clearer guidelines, clarity of remit and roles amongst service providers are necessary in addition to educational interventions directed at patients and health-care professionals in improving physical health monitoring, counselling and management of patients prescribed antipsychotic medicines. TRIAL REGISTRATION: A protocol was developed and registered with PROSPERO as per PRISMA-P guidelines ( CRD 42018106002 ).

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