Article Figures & Data
Tables
Baseline 4 Weeks 8 Weeks 12 Weeks Quarterly Annually Every 5 Years Personal/family history x x Weight (BMI) x x x x x Waist circumference x x Blood pressure x x x Fasting glucose x x x Fasting lipids x x x *More frequent assessment may be warranted based on clinical status.
BMI, body mass index.
Copyright © 2004 American Diabetes Association. From Diabetes Care®, Vol. 27, 2004; 596–601. Reprinted with permission from The American Diabetes Association.
Drug Weight Gain Risk for Diabetes Worsening Lipid Profile Clozapine +++ + + Olanzapine +++ + + Risperidone ++ D D Quetiapine ++ D D Aripiprazole* ± – – Ziprasidone* ± – – ↵* Newer drugs with limited data.
+, increased effect (the more + symbols the greater the effect); –, no effect; D, discrepant results.
Copyright © 2004 American Diabetes Association. From Diabetes Care®, Vol. 27, 2004; 596–601. Reprinted with permission from The American Diabetes Association.
Model Description Limitations Setting Clinician Involvement Dually trained physicians48,49,57 Physician trained in both psychiatric and physical medicine manages all care Few available, may not maintain sufficient skills for complex medical care, may not be optimal use of resources High concentration of medical comorbidity, eg, inpatient and chemical-dependency treatment centers High Physical medicine on-site consultation41,50 Physical medicine clinician provides consultation and care within psychiatric clinic or inpatient setting Expensive unless volume is sufficient to fill consultant's schedule Concentrated medical comorbidity, eg, inpatient and addiction centers or as outreach model for large clinics managing many SMI patients seen in limited number of psychiatric clinics High Collaborative care45,51,52 Frequent communication between mental and physical health care teams Requires un-reimbursed communication time, added attention to HIPAA compliance, and supportive communication infrastructure (eg, secure e-mail, telephone access, medical record access) Financially and administratively integrated systems with shared medical records, eg, HMOs and VA, co-located clinics Intermediate Case manager53,54 Often a registered nurse who coordinates transportation and appointments, monitors health status and treatment adherence Time intensive for nurse, potentially expensive Any setting with sufficient volume of patients Low Facilitated referral to primary care55,56 Psychiatric care team facilitates access to primary care team Requires sufficient primary care access in community Private clinics, geographically dispersed practice locations Intermediate SMI, serious mental illness; HIPAA, Health Insurance Portability and Accountability Act; HMO, health maintenance organization; VA, Veteran's Association.
Adapted and expanded from framework of Druss and Bower.50,58
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