Mind the Body: Investigating Metabolic Screening and Intervention Practices for Rural Patients

Joshua Burgmann

Introduction:

Metabolic syndrome is a widespread and preventable source of excess mortality in adults prescribed antipsychotic medications. Rural populations may be at an increased risk of metabolic syndrome, however the literature on rural adults with a psychiatric condition is limited.

Aim:

This study aimed to identify the rate of metabolic syndrome in inpatients prescribed antipsychotics, outline screening and intervention rates, and establish what metabolic health interventions are routinely used in clinical practice.

Method:

Data was collected for n=100 rural patients aged 18-64 , who were prescribed antipsychotic medications, and were admitted to the acute inpatient unit for seven days.

Results:

The prevalence of metabolic syndrome in this rural population was relatively high at 50.7-51.5%. Screening rates were relatively high for both biochemical tests (94% [n=94/100] of participants received ≥1 blood test), and clinical assessment (ranging from 78% [n=78/100] screened for waist circumference to 100% [n=100/100] screened for blood pressure). Intervention rates were low with 1.6% (n=1/62), 5.4% (n=3/56), and 9.5% (n=7/74) of participants receiving specific treatment for abnormal blood pressure, excessive waist circumference and smoking respectively. Higher intervention rates were found for less complex conditions, 96% (n=24/25) were treated for vitamin D deficiency, with lower rates found for more complex management, 31.3% (n=10/32) treated for deranged glucose.

Conclusions:

Rural patients prescribed antipsychotics have high rates of metabolic syndrome relative to the general population with a similar prevalence to urban psychiatric populations. Physical health interventions were poorly utilised given high screening rates, particularly for more complex physical health management which was frequently referred to general practitioners. Findings from this study will inform Phase 2 – implementation of clinical education sessions and a metabolic health treatment algorithm to improve future psychiatric physical health management.