features

Metabolic monitoring is critical for patients with schizophrenia disorder

According to the U.S. Center for Disease Control and Prevention, heart disease and diabetes are among the top 10 leading causes of death in the United States. Persons with serious mental illness on antipsychotic medications are at increased risk for diabetes and cardiovascular disease. Lack of appropriate monitoring can lead to the emergence or worsening of these health conditions. Patients with these illnesses have a high incidence of non-adherence with diet and exercise recommendations.

To support the ongoing treatment of individuals with serious mental illness, including schizophrenia or bipolar disorder, healthcare organizations, including health plans, collect quality data through measures known as the Healthcare Effectiveness Data and Information Set (HEDIS^®).

Three key HEDIS measures track effectiveness of metabolic monitoring for patients prescribed antipsychotic medication

1. Diabetes screening for people with schizophrenia or bipolar disorder who are using antipsychotic medications (SSD): Measures if a diabetes screening test was completed for adults aged 18–64 with schizophrenia, schizoaffective disorder, or bipolar disorder who were dispensed an antipsychotic medication during the measurement year.
2. Diabetes monitoring for people with diabetes and schizophrenia (SMD): Measures LCL-C testing and HbA1c testing during the measurement year for adults aged 18–64 with schizophrenia, schizoaffective disorder, and diabetes.
3. Cardiovascular monitoring for people with cardiovascular disease and schizophrenia (SMC): Measures LDL-C testing during the measurement year for adults aged 18–64 with schizophrenia, schizoaffective disorder, and cardiovascular disease.

Ways to support patients who are taking antipsychotic medications

• Use second-generation antipsychotics for approved indications.
• Base selection of antipsychotics on individual risk factors for each patient:
  • previous response
  • side effect profiles
  • family history
  • co-morbid conditions
  • medical vulnerabilities
  • tolerances
  • patient preference/expectations.
• Follow FDA-recommended  screening measures for monitoring patients using second-generation antipsychotics. These guidelines may be modified with changes in medication and/or as clinically indicated: 

By focusing on these measures, providers can improve patient outcomes, reduce hospital readmissions, and promote positive outcomes. Supporting these quality goals not only benefits patient health and recovery but also strengthens system performance and satisfaction across the healthcare continuum.

Find more information about behavioral health HEDIS measures at www.ncqa.org/hedis/.

References:

1. Diabetes and Cardiovascular Disease Screening and Monitoring for People with Schizophrenia or Bipolar Disorder (SSD, SMD, SMC). Retrieved from www.ncqa.org
2. Second Generation (atypical) antipsychotic medications tip sheet. Retrieved from: https://www.magellanprovider.com/media/11781/second_gen_antipsychotic.pdf  
3. Prescribing Guidelines for Second-Generation Antipsychotics. Retrieved from: https://www.magellanprovider.com/media/11780/guidelines_atypicalantipsychotics.pdf   
4. CDC/National Center for Health Statistics. Deaths and Mortality. May 2, 2024. Retrieved from: https://www.cdc.gov/nchs/fastats/deaths.htm  
5. The APA Practice Guideline for the Treatment of Patients w Schizophrenia, Third Edition. Copyright 2021. https://doi.org/10.1176/appi.books.9780890424841
6. Chokhawala K, Stevens L. Antipsychotic Medications. [Updated 2023 Feb 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519503/
7. DeJongh BM. Clinical pearls for the monitoring and treatment of antipsychotic induced metabolic syndrome. Ment Health Clin. 2021 Nov 8;11(6):311-319. doi: 10.9740/mhc.2021.11.311. PMID: 34824956; PMCID: PMC8582768.