Keywords: Covid-19; Health Reviews; Serious mental illness; psychosis; cardiovascular disease
Antipsychotics are associated with metabolic disturbances adversely affecting cardiometabolic health. Routine cardiometabolic monitoring is subsequently an important component of care in patients on antipsychotics. During the Covid-19 pandemic there has been a transition towards remote consulting. Understanding the effect of the pandemic on routine primary care activity may help avoid potential adverse health outcomes.
This study aimed to identify the local impact of the Covid-19 pandemic on cardiometabolic monitoring in patients on antipsychotics.
A cross-sectional analysis was performed of patients on antipsychotic medications at a suburban South-West London practice. Patients were identified through a search via EMIS Web. Inclusion criteria included those registered permanently and commenced on medication prior to 17th December 2018. Primary outcomes included difference in yearly incidence of recorded weight, waist circumference, pulse, blood pressure, fasting blood glucose, HbA1c and lipids. Statistical significance was defined by p<0.050.
Fifty-three patients met the inclusion criteria. The mean patient age was 52.2 (±17.4). A total of 64 antipsychotics were on repeat prescriptions, with quetiapine (n=18; 28.1%) and olanzapine (n=18; 28.1%) being the most commonly prescribed. Comparing 2019 against 2020, there was no statistically significant difference in incidence of recorded weight (2019:49.2%; 2020:49.2%; p=0.698), waist circumference (2019:10.2%; 2020:6.8%; p=0.486), pulse (2019:20.3%; 2020:11.9%; p=0.672), blood pressure (2019:59.3%%; 2020:44.1%; p=0.821), fasting blood glucose (2019:5.1%; 2020:0.0%; p=1.000), HbA1c (2019:72.9%; 2020:49.2%; p=0.613), lipids (2019:55.9%; 2020:39.0%; p=0.251).
A reduction in cardiometabolic monitoring was observed in this studied population, locally, in 2020. This was not statistically significant but may be clinically significant on an individual patient basis for long-term health outcomes. It is important that any potential adverse effects on different populations of increased remote consulting during and beyond the Covid-19 pandemic are identified, so that health systems may be reconfigured to ensure robust follow up and reduce excess mortality.
Points for discussion:
Cardiometabolic monitoring has declined in this study during the Covid-19 pandemic in this at risk group - how can primary care address the shortfall of activity created by the pandemic?
How will primary care best adjust its consulting structure in the future to ensure that a drive towards remote consultations does not affect the ability for different patient populations to access care?
Does remote consulting widen health inequalities?