The apparent shift in the prescribing pattern without increased laboratory testing may reflect the “diffusion and behavior change” theory of communication and response, Morrato and colleagues posit. This theory, they explain, “would predict that it is easier to adopt behaviors for which the relative advantage is clear and compatible with existing experience and practice than to adopt behaviors with greater perceived complexity or that are designed to lower the probability of some unwanted future event.”
The low rates of laboratory testing for the metabolic adverse effects of second-generation antipsychotics was not attributed by Morrato and colleagues to a lack of awareness of the warnings and guidelines among psychiatrists, because postwarning surveys showed that this group has a high level of knowledge about the need for metabolic testing. An additional disparity is that 60% to 80% of surveyed psychiatrists reported obtaining glucose and lipid levels at regular intervals for patients receiving second-generation antipsychotics.
Morrato and colleagues consider the possibility that there is less awareness of the recommended laboratory monitors among primary care providers, who may have more patients taking these medications or who, in some practices, are responsible for the laboratory orders of patients they refer for psychiatric consult.
The gap between reported monitoring behavior and observed monitoring rates needs to be further studied, Morrato and colleagues conclude, “before improvements can be made in diabetes and dyslipidemia screening for this at-risk population.”