Managing metabolic syndrome in a partial hospitalization program: a feasibility study. Life Enhancement program. The Queen s Medical Center

Transcription

1 Day Treatment Services Managing metabolic syndrome in a partial hospitalization program: a feasibility study Renee Latimer, APRN-BC, MS, MPH Rose Clute, APRN-BC, Rx, MS Life Enhancement Program Honolulu, HI Began in programs 4,525 patients per year 2 focus on mental illness 3 focus on dual diagnosis Feasibility study focused on 5 day acute mental illness (Life Enhancement program) This speaker has no conflicts of interest or commercial support to disclose. Life Enhancement program Primary dx chronic or new onset serious mental illness 2 tracks depending on level of function Focus is on safety, symptom management, illness education, bridging to family and social support Average LOS is 150 days Life Enhancement program Founded in 1859 by Queen Emma and King Kamehameha IV Private, non-profit hospital Licensed for 505 beds, with over 1100 nurses Granted Magnet designation in April, 2009 Mission: provide in perpetuity quality health care services to improve the well-being of Native Hawaiians and all the people of Hawai i Team: 3 SWs, 2-3 BHAs, 1 APRN, ½ MD, [art therapist, OTR- supplemental] APRN role Admission i health hx, medication dispensing, i education and management Focus on illness self-management Previous wellness ed focused on general health topics with no set curriculum Latimer & Clute 1

2 Background - literature Persons with serious mental illness are up to 2 times more likely to develop diabetes Cardiovascular disease is the leading cause of death in persons with SMI 6 years after the ADA-APA consensus statement, glucose and lipid testing for SGAtreated adults was infrequent. More effort is needed to improve diabetes and dyslipidemia screening in these at-risk patients [Morrato et al, Diabetes Care 2009 Jun;32(6)] Metabolic Syndrome Elevated waist circumference: 40 inches in men, 35 inches in women; Elevated triglycerides: 150 mg/dl (or on drug treatment for elevated triglycerides; Reduced HDL-C: 40 mg/dl in men, 50 mg/dl in women; Elevated blood pressure (BP): 130 mm Hg systolic BP or 85 mm Hg diastolic BP; Elevated fasting glucose: 100 mg/dl. NHLBI, Third Report of the Expert Panel on Detection, Evaluation, and Treatment of the High Blood Cholesterol in Adults (Adult Treatment Panel III): American Diabetes Association (ADA) and the American Psychiatric Association (APA) [2005] Measures CONSENSUS GUIDELINES 1. consideration of metabolic risks when starting medications 2. patient, family, and caregiver education 3. baseline screening 4. regular monitoring 5. referral to specialized programs for weight management. participant attendance and satisfaction with sessions pre and post test scores of knowledge Perceived level l of physical activity it Perceived nutritional intake. assessment of trends in participants weight, BP, waist circumference, FBG, HbA1c, lipid profiles over 3 months Research Question & Design to test the feasibility of implementing HealthWatch, a program for the management of metabolic syndrome, adapted for a partial hospitalization program serving the seriously mentally ill. quasi-experimental one group, pre-/posttest design Feasibility study (n=20) Proposed Intervention 1. SugarWatch, a locally developed curriculum shown to be successful in improving risk factors for metabolic syndrome in a study targeting Asian Americans and Pacific Islanders 2. structured physical activity to meet recommendations 3. Create-a-plate lunch 1 day/week Latimer & Clute 2

3 Curriculum Results: Demographics Session 1: Create-a-Plate Session 2: Stepping Out Session 3: Be a Buddy Session 4: Check your Health Session 5: Talk to Your Doc Session 6: Planning for the Road Ahead Male 60% Mean age 43 yo; 80% < 50 yo Mean years of education = 13.2 (range 11-20) 65% AA/PI; 25% more than 1 ethnicity Family hx of diabetes (45%) and hypertension (60%) 35% were smokers Physical activity Baseline results Increase in-program walking to 150 minutes per week (five 30-minute sessions). LE Program schedule of classes was shifted to accommodate daily walking LE Program staff assisted with the walking sessions. BMI SBP DBP Waist circumference FBG HbA1c TC LDL HDL TG Create a Plate Feasibility measures 37 consented; 20 participants completed 3 months Participation in HealthWatch education 85% attended d 4 or more sessions 40% attended all 6 sessions During the study period (24 weeks); 4 or more walking sessions/week for 83% of the weeks Latimer & Clute 3

4 Results End of study lab values n=13 No significant differences for the following measures: Weight, BMI, Waist circumference Lipids, FBG, HbA1c # of MD visits in last 6 months Perceived health status Limitations No money, honey Feasibility study Weak design Small sample size (n=20) No control for extraneous variables (changes in medication, etc) Post-intervention lab results incomplete Results Decrease in SBP was significant! A recent meta-analysis showed pre- hypertensive BP was linked with an increased risk for stroke. (Lee, 2011) pre-hypertensive: SBP ; DBP Why does this make sense? Numerous studies show that physical activity (walking) can lower BP in various groups Practice Change and Sustainability Baseline lab screening has been instituted at intake: lipids, FBG, HbA1c Health & Wellness curriculum is standard part of weekly LE program Daily walking or other activity has been incorporated into the LE program Awareness of healthier lunch options is increasing Other results One person stopped smoking Knowledge increased slightly, but not significantly Satisfaction measured qualitatively ti l Activities and curriculum well liked Long presentations and discussions less liked The daily walks generated mixed feelings Acknowledgements Yuri Popov, RN, Staff Nurse; QMC BH Robin Westlake, BSW; QMC LE The LE Team: Jaime Mendoza, Evarts Fox III, Neilani i Siatini, i Mike Gatti, Devin Takahashi Latimer & Clute 4

5 References 1. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care, (2): p McElroy, S.L., Obesity in patients with severe mental illness: overview and management. J Clin Psychiatry, Suppl 3: p NHLBI, Third Report of the Expert Panel on Detection, Evaluation, and Treatment of the High Blood Cholesterol in Adults (Adult Treatment Panel III): McCreadie, R.G., Diet, smoking 4. and cardiovascular risk in people with schizophrenia: descriptive study. Br J Psychiatry, : p Kiraly, 5. B., K. Gunning, and J. Leiser, Primary care issues in patients with mental illness. Am Fam Physician, (3): p Stahl, S.M., L. Mignon, and J.M. Meyer, Which comes first: atypical antipsychotic treatment or cardiometabolic risk? Acta Psychiatr Scand, (3): p Lieberman, J.A., Comparative 7. effectiveness of antipsychotic drugs. A commentary on: Cost Utility Of The Latest Antipsychotic Drugs In Schizophrenia Study (CUtLASS 1) and Clinical Antipsychotic Trials Of Intervention Effectiveness (CATIE). Arch Gen Psychiatry, (10): p Conley, R.R. and D.L. Kelly, Second-generation antipsychotics for schizophrenia: a review of clinical pharmacology and medication- associated side effects. Isr J Psychiatry Relat Sci, (1): p Hawaii, A.S.o., Report to the twenty-fifth legislature: State of Hawaii , AMHD. 10. Reyes-Salvail, F., S. Liang, and D.-H. Nguyen, Frequent Mental Distress Prevalence and Disparity: Hawaii BRFSS Alvarez-Jimenez, M., et al., Non-pharmacological management of antipsychotic-induced weight gain: systematic review and metaanalysis of randomised controlled trials. Br J Psychiatry, (2): p Gabriele, J.M., P.M. Dubbert, and R.R. Reeves, Efficacy of behavioural interventions 12. in managing atypical antipsychotic weight gain. Obes Rev, (4): p Grandinetti, A., et al., Metabolic syndrome 13. in a multiethnic population in rural Hawaii. Ethn Dis, (2): p Latimer R., R.S., Kimura, M. Mau, Health disparities in the workplace: Opportunities for intervention in an Asian/Pacific Islander (AAPI) population with or at high risk for Type 2 diabetes Knowler, W.C., et al., Reduction in the incidence of type diabetes with lifestyle intervention or metformin. N Engl J Med, (6): p Kriska, A.M., 16. et al., Development of questionnaire to examine relationship of physical activity and diabetes in Pima Indians. Diabetes Care, (4): p Glanz, K., et al., Development 17. and validation of measures of psychosocial factors influencing fat- and fiber-related dietary behavior. Prev Med, (3): p Morrato et al, Diabetes Care Jun;32(6)] Latimer & Clute 5