Barriers and facilitators to implementation of a metabolic monitoring protocol in hospital and community settings for second-generation antipsychotic-treated youth

Objective: 1) Assess perceived barriers associated with metabolic monitoring in second-generation antipsychotic (SGA)-treated youth; and 2) Propose a metabolic monitoring protocol (MMP) and implementation strategies.

Method: Online surveys were created for community mental health teams (CMHTs) and BC Children's Hospital (BCCH) with questions designed to evaluate knowledge of physical health care, confidence, communication with primary care, and practical issues.

Results: 26/50 (52%) of CMHT and 44/111 (40%) of BCCH surveys were completed. While both groups agreed that monitoring is their responsibility, 26% of CMHTs and 35% of BCCH professionals agreed that providing information about SGA side-effects would influence medication adherence. CMHTs reported lower overall confidence and more practical issues as monitoring barriers. While higher overall confidence was reported at BCCH, there was still a substantial proportion (23%) of hospital professionals who reported not knowing what parameters to monitor and how frequently. Communication with primary care, including inadequate systems for sharing results and identifying responsibility for acting on abnormal results, appear to be common barriers shared by both settings.

Conclusions: Barriers to metabolic monitoring were more frequently reported by CMHTs who had limited access to nursing staff. We propose hands-on training, educational resources, pre-printed orders, and regular quality assurance evaluation as facilitators to promote MMP uptake.