Annual Metabolic Monitoring and Clinical Follow-Through in Adults Prescribed Antipsychotics in Community Care: A Restricted-Search Systematic Review and Exploratory Meta-Analysis

Annual metabolic monitoring is a minimum component of care for many adults receiving antipsychotics, but recorded testing and subsequent clinical action are distinct outcomes.This review assessed annual monitoring in community care and examined evidence of follow-through after abnormalities.Europe PMC was searched from inception to September 8, 2026, using explicit antipsychotic, metabolic monitoring, and annual/community care concepts, supplemented by seven additional study reports available to the research team.Adult outpatient and primary care studies reporting annual or annual-equivalent monitoring were eligible.Study screening, data extraction, and quality appraisal were performed by the first author, with methodological supervision and review by the second author.Exact patient-level counts for annual coverage during ongoing treatment were synthesised using logit random-effects models, restricted maximum likelihood, and modified Hartung-Knapp confidence intervals (CIs).Treatment-initiation windows, frequency targets, paired time points, and inconsistent denominators were not pooled with annual coverage.In total, 16 reports representing 15 study programmes were included; 15 reports remained unavailable for full-text assessment after the original retrieval attempts.Five studies contributed to at least one metaanalysis.Glycaemic monitoring was 42.4% (95% CI = 18.8-70.1;five studies, 18,942 participants), lipid monitoring 33.0% (9.2-70.6;four studies, 2,188 participants), blood pressure recording 29.6% (1.7-91.2;four studies, 2,188 participants), and weight recording 31.6%(0.3-98.5; three studies, 222 participants).Heterogeneity was extreme (I² = 96.8-99.2%).No compatible dataset supported pooling timely clinical action among patients with newly confirmed abnormalities.Selection and documentation bias were common.Available studies show substantial gaps in documented annual monitoring, with marked variation between services.The pooled estimates are exploratory and are not reliable service benchmarks.Evidence on timely responses to abnormal results remains insufficient.Restricted searching, inaccessible reports, and the absence of independent duplicate screening and extraction limit confidence in the synthesis.