Difficulties in monitoring cardiometabolic risk in the chronic use of atypical antipsychotics for non-traditional indications, in a specialty hospital in Argentina: a qualitative study

María N. Vivacqua, Servicio de Psiquiatría, Universidad Hospital Italiano de Buenos Aires, Hospital Italiano de Buenos Aires, Argentina
María F. Grande-Ratti, Área de Investigación en Medicina Interna, Hospital Italiano de Buenos Aires, Argentina
José L. Faccioli, Servicio de Psiquiatría, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

Objective: To explore the barriers that hinder the proper monitoring of adverse effects in patients prescribed antipsychotics in a medical specialty hospital in Argentina. Method: A qualitative interpretive study of narrative design with ten semi-structured individual interviews with doctors from various specialties, conducted in outpatient clinics between May and November 2022, with an ad hoc guide based on a bibliography. Results: Barriers in interpersonal relationships emerged, highlighting the insufficient duration and infrequent consultations, communication problems between professionals and between professionals and their patients, and difficulties in teamwork. The obstacles were related to 1) limited direct communication; 2) communication via electronic medical records (without prior agreement or confirmation of receipt of messages); 3) use of patients as intermediaries for message exchange; 4) disregarding another professional’s indications without communicating with them; 5) expressing differing criteria to the patient, delegating responsibility for treatment decisions to the patient; 6) assuming that antipsychotic monitoring is carried out by another professional; 7) hierarchies that hinder communication, and 8) experienced medical referents. These topics relate to inherent healthcare system issues, mainly the lack of available time and communication between colleagues as an unpaid task. Conclusions: Communication barriers imposed by the healthcare system can result in misunderstandings that lead to suboptimal health outcomes. Sharing this information could guide organizations in developing strategies to improve communication and facilitate teamwork in hospital settings.

Keywords: Antipsychotic agents. Drug monitoring. Communication. Cardiometabolic adverse effects. Qualitative research.