Improving Metabolic Screening in Diverse Severely Mentally Ill Populations

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DESCRIPTION (provided by applicant): This application for a K23 Mentored Patient-Oriented Research Career Development Award will support critical additional training for the candidate, Dr. Christina Mangurian, a psychiatrist at the University of California, San Francisco (UCSF), based at San Francisco General Hospital. Dr. Mangurian's research plan focuses on improving metabolic screening among ethnically and racially diverse severely mentally ill populations served in community mental health clinics. To further develop her career as a mental health services researcher and to accomplish her research plan, she requires specific training in three areas: 1) clinical research methods (e.g., biostatistics, epidemiology, and mixed methods); 2) implementation research; and 3) mental health disparities research. Dr. Mangurian has assembled a multidisciplinary team of mentors to facilitate her training and research. Her primary mentor is Dr. Dean Schillinger, a UCSF primary care internist with international expertise in primary care health services research, including implementation research in public health settings. He will oversee all training and research plans, providing his wealth of experience in this field, including his dedication to improving services for underserved populations. His expertise will be complemented by Dr. Martha Shumway, a UCSF mental health services researcher; and Dr. John Newcomer, a Washington University clinical investigator who is an expert in clinical and laboratory measurement of metabolic risk in severely mentally ill populations and in the translation of monitoring objectives into clinical practice. People with severe mental illness die, on average, 25 years earlier than the general population, most often from cardiovascular disease. Metabolic abnormalities (e.g., diabetes, hypertension, dyslipidemia) resulting from antipsychotic medications used to treat this population can lead to increased rates of cardiovascular disease. Despite national guidelines emphasizing the importance of screening, metabolic screening rates for this population remain low. There is an urgent need for evidence-based, generalizable interventions that can be feasibly implemented to improve metabolic screening at community mental health clinics where this vulnerable population is primarily served. Therefore, in Aim 1, Dr. Mangurian proposes to characterize metabolic screening rates among adults with severe mental illness who receive services at community mental health clinics in San Francisco County. In Aim 2, she will tailor an intervention to improve metabolic screening for adults with severe mental illness by engaging multiple stakeholders and focusing on barriers that may impact high-risk racial/ethnic subpopulations. In Aim 3, she will conduct a pilot study of the intervention. The results of this research will contribute new information about implementation efforts to improve metabolic screening in community mental health clinics and will form the basis of an R01 application to study the effectiveness of this intervention. PUBLIC HEALTH RELEVANCE: The majority of people with severe mental illness are prescribed antipsychotic medications, many of which result in metabolic abnormalities (e.g., dyslipidemia, diabetes) and in turn increase cardiovascular risk. We will evaluate whether a pragmatic intervention - a mandatory annual metabolic screening visit by a psychiatrist, which is linked to a web-based electronic referral and clinical decision support tool - can be feasibly implemented at community mental health clinics to enhance early detection and treatment of metabolic disorders and thereby reduce the high prevalence of cardiovascular disease among people with severe mental illness.