Cardiometabolic monitoring in children and adolescents prescribed antipsychotics in Australian primary care, 2011 to 2017.

objectiveTo determine the extent of cardiometabolic monitoring occurring in children/adolescents 18 years and under receiving antipsychotics in Australian general practice: study period 2011 to 2017.

methodsRetrospective cohort study using large primary care database, MedicineInsight. Rates of monitoring within 12 months of patients receiving an incident antipsychotic prescription were reported descriptively for weight, body mass index (BMI), waist circumference (WC), glucose, total cholesterol, triglycerides, high-density lipoproteins (HDL), blood pressure, liver function, prolactin, and metabolic syndrome (MetS) defined as weight, blood pressure and glucose. Target trial methodology was used to examine whether monitoring rates were higher in patients prescribed antipsychotics compared to patients not receiving antipsychotics.

results55.9% of patients using antipsychotics were monitored at least once on at least one parameter. Weight was most frequently measured (39.1% patients measured at least once), followed by BMI (31.2%), blood pressure (29.0%), glucose (12.9%), liver function (9.1%), total cholesterol (8.1%), triglycerides (6.7%), HDL (3.1%), WC (1.6%) and prolactin (1.1%). Monitoring for MetS occurred at least once in 1.5% of patients. Antipsychotic users recorded a small but significantly higher rate of monitoring than non-users (1.157 vs 0.691 monitoring visits for any parameter within the 12 month measurement period, difference 0.461; 95% CI [0.271, 0.660],

conclusionRates of cardiometabolic monitoring were well below guideline recommendations. Our results suggest the need for education and training to increase awareness of adverse health impacts of antipsychotics and improve adherence to cardiometabolic guideline recommendations. Communication between primary and secondary health care providers also needs to be addressed.