Opinions of primary care clinicians and psychiatrists on monitoring the metabolic effects of antipsychotics

Abstract

Objective: Although people with severe mental illness (SMI) have high rates of diabetes and other metabolic disorders, adherence to recommended screening guidelines is low. This study aimed to compare primary care clinicians’ and psychiatrists’ attitudes toward metabolic monitoring and treatment of patients with SMI. Methods: Primary care clinicians and psychiatrists within 1 large urban integrated public health system were recruited to participate in this online survey study. Multivariate logistic regression analyses were used to examine if clinician characteristics were associated with attitudes or perceived barriers toward metabolic monitoring and treatment. Results: Response rates were 77% (164/214) of primary care providers and 69% (56/81) of psychiatrists completing the survey. There were no significant differences in age or race/ethnicity between provider groups, although primary care clinicians were more likely to be women when compared with the psychiatrists (69% vs 39%, P < .001). Psychiatrists were more likely than primary care clinicians to believe that psychiatrists should conduct metabolic monitoring even if patients had a primary care provider (80% vs 60%, P .011) However, fewer psychiatrists than primary care clinicians believed that psychiatrists should treat identified cardiometabolic abnormalities (15% vs 42%, P < .001). Conclusion: Systemic problems with care coordination and these varying expectations likely contribute to poor cardiometabolic outcomes in this vulnerable population.