Top

Journal of General Internal Medicine

Published in:

01-07-2009 | Original Article

Retrospective Analysis of Diabetes Care in California Medicaid Patients with Mental Illness

Authors: Jim E. Banta, PhD, MPH, Elaine H. Morrato, DrPH, MPH, Scott W. Lee, MD, Mark G. Haviland, PhD

Published in: Journal of General Internal Medicine | Issue 7/2009

Abstract

Background

Serious mental illness often is associated with an increased risk of diabetes and sub-optimal diabetes care.

Objective

To examine diabetes prevalence and care among Medicaid patients from one county mental health system.

Design

Retrospective cohort study combining county records and 12 months of state Medicaid claims.

Subjects

Patients ages 18 to 59 receiving mental health services between November 1 and 14, 2004.

Measurements

Dependent variables were glycolated hemoglobin A1C (HbA1c) testing, lipid testing, and eye examinations. Psychiatric status was assessed by second generation antipsychotic prescription (SGA) and low Global Assessment of Functioning (GAF) score.

Results

Among psychiatric patients, 482 (11.8%) had diabetes. Among those with diabetes, 47.3% received annual HbA1c testing, 56.0% lipid testing, and 31.7% eye examinations. Low GAF scores were associated with lower likelihood of lipid testing (OR 0.43). SGA prescription reduced the likelihood of HbA1c testing (OR 0.58) but increased the likelihood of eye examinations (OR 2.02). Primary care visits were positively associated with HbA1c and lipid testing (ORs 5.01 and 2.21, respectively). Patients seen by a fee-for-service psychiatrist were more likely to have lipid testing (OR 2.35) and eye examinations (OR 2.03).

Conclusion

Among Medicaid psychiatric patients, worse diabetes care was associated with SGA prescription, more serious psychiatric symptoms, and receiving psychiatric care only in public mental health clinics. Diabetes care improved when patients were seen by fee-for-service psychiatrists or primary care physicians. Further study is needed to identify methods for improving diabetes care of public mental health patients.

Long SK, Coughlin TA, Kendall SJ. Access to care among disabled adults on Medicaid. Health Care Financ Rev. 2002;23:159–73.PubMed

Colton CW, Manderscheid RW. Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prev Chronic Dis [serial online]. 2006. Available at: http://www.cdc.gov/pcd/issues/2006/apr/05_0180.htm. Accessed on April 20, 2008.

Weitoft GR, Gullberg A, Rosen M. Avoidable mortality among psychiatric patients. Soc Psychiatry Psychiatr Epidemiol. 1998;33:430–7.CrossRef

Dixon L, Weiden P, Delahanty J, et al. Prevalence and correlates of diabetes in national schizophrenia samples. Schizophr Bull. 2000;26:903–12.PubMed

Van Winkel R, De Hert M, Van Eyck D, et al. Prevalence of diabetes and the metabolic syndrome in a sample of patients with bipolar disorder. Bipolar Disord. 2008;10:342–8.PubMedCrossRef

Li C, Ford ES, Strine TW, Mokdad AH. Prevalence of depression among U.S. adults with diabetes: findings from the 2006 Behavioral Risk Factor Surveillance System. Diabetes Care. 2008;31:105–7.PubMedCrossRef

Newcomer JW. Metabolic considerations in the use of antipsychotic medications: a review of recent evidence. J Clin Psychiatry. 2007;68(Suppl 1):20–7.PubMed

Guo JJ, Keck PEJ, Corey-Lisle PK, et al. Risk of diabetes mellitus associated with atypical antipsychotic use among Medicaid patients with bipolar disorder: A nested case-control study. Pharmacotherapy. 2007;27:27–35.PubMedCrossRef

Morrato EH, Newcomer JW, Allen RR, Valuck RJ. Prevalence of baseline serum glucose and lipid testing in users of second-generation antipsychotic drugs: A retrospective, population-based study of Medicaid claims data. J Clin Psychiatry. 2008;69:316–22.PubMedCrossRef

10.

Piette JD, Kerr EA. The impact of comorbid chronic conditions on diabetes care. Diabetes Care. 2006;29:725–31.PubMedCrossRef

11.

Kilbourne AM, Welsh D, McCarthy JF, Post EP, Blow FC. Quality of care for cardiovascular disease-related conditions in patients with and without mental disorders. J Gen Intern Med. 2008;23:1628–33.PubMedCrossRef

12.

Frayne SM, Halanych JH, McDonald DR, et al. Disparities in diabetes care: Impact of mental illness. Arch Internal Med. 2005;165:2631–8.CrossRef

13.

Lin EHB, Katon W, Von Korff M, et al. Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care. 2004;27:2154–60.PubMedCrossRef

14.

Krein SL, Bingham CR, McCarthy JF, Mitchinson A, Payes J, Valenstein M. Diabetes treatment among VA patients with comorbid serious mental illness. Psychiatr Serv. 2006;57:1016–21.PubMedCrossRef

15.

Whyte S, Penny C, Phelan M, Hippisley-Cox J, Majeed A. Quality of diabetes care in patients with schizophrenia and bipolar disorder: Cross-sectional study. Diabet Med. 2007;24:1442–8.PubMedCrossRef

16.

Rosenheck RA, Stolar M. Access to public mental health services: Determinants of population coverage. Med Care. 1998;36:503–12.PubMedCrossRef

17.

Piette JD. Perceived access problems among patients with diabetes in two public systems of care. J Gen Intern Med. 2000;15:797–804.PubMedCrossRef

18.

Sambamoorthi U, Olfson M, Wei W, Crystal S. Diabetes and depression care among Medicaid beneficiaries. J Health Care Poor Underserved. 2006;17:141–61.PubMedCrossRef

19.

Andersen RM, Davidson PL. Improving Access to Care in America: Individual and Contextual Indicators. In: Andersen RM, Rice TH, Kominski GF, eds. Changing the U.S. Health Care System. 3rd ed. San Francisco: Jossey-Bass; 2007:3–32.

20.

Gelberg L, Andersen RM, Leake B. The Behavioral Model for Vulnerable Populations: Application to medical care use and outcomes for homeless people. Health Serv Res. 2000;34:1273–1302.PubMed

21.

Desai MM, Rosenheck RA, Kasprow WJ. Determinants of receipt of ambulatory medical care in a national sample of mentally ill homeless veterans. Med Care. 2003;41:275–87.PubMedCrossRef

22.

Harris K. Personal communication, email from San Bernardino County Department of Behavioral Health Research and Evaluation section, November 29, 2007.

23.

Cunningham P, McKenzie K, Taylor EF. The struggle to provide community-based care to low-income people with serious mental illness. Health Aff (Millwood). 2006;25:694–705.CrossRef

24.

Tungstrom S, Soderberg P, Armelius BA. Relationship between the Global Assessment of Functioning and other DSM axes in routine clinical work. Psychiatr Serv. 2005;56:439–43.PubMedCrossRef

25.

Meduru P, Helmer D, Rajan M, Tseng C-L, Pogach L, Sambamoorthi U. Chronic illness with complexity: Implications for performance measurement of optimal glycemic control. J Gen Intern Med. 2007;22(Suppl 3):408–18.PubMedCrossRef

26.

Kerr EA, Heisler M, Krein SL, et al. Beyond comorbidity counts: How do comorbidity type and severity influence diabetes patients’ treatment priorities and self-management? J Gen Intern Med. 2007;22:1635–40.PubMedCrossRef

27.

U.S. Department of Health and Human Services. Healthy People 2010. Available at: http://www.healthypeople.gov/Document/tableofcontents.htm#uih. Accessed on May 14, 2008.

28.

Goldberg RW, Kreyenbuhl JA, Medoff DR, et al. Quality of diabetes care among adults with serious mental illness. Psychiatr Serv. 2007;58:536–43.PubMedCrossRef

29.

Saaddine JB, Cadwell B, Gregg EW, et al. Improvements in diabetes processes of care and intermediate outcomes: United States, 1988–2002. Ann Intern Med. 2006;144:465–74.PubMed

30.

Marder SR, Essock SM, Miller AL, et al. Physical health monitoring of patients with schizophrenia. Am J Psychiatry. 2004;161:1334–49.PubMedCrossRef

31.

Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2007. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2008.

32.

Glazier RH, Bajcar J, Kennie NR, Wilson K. A systematic review of interventions to improve diabetes care in socially disadvantaged populations. Diabetes Care. 2006;29:1675–88.PubMedCrossRef

33.

Druss BG. Improving medical care for persons with serious mental illness: Challenges and solutions. J Clin Psychiatry. 2007;68(Supplement 4):40–4.PubMed

34.

Koran LM, Sox HC, Marton KI, et al. Medical evaluation of psychiatric patients. Arch Gen Psychiatry. 1989;46:733–40.PubMed

35.

Mayberg SW. California’s Community Mental Health Performance Outcome Report, Fiscal Year 2002–2003: California Department of Mental Health; March 2003.

36.

Labby D, Spofford M, Robinson J, Ralston R. The economics of depression in primary care: Defragmentation in the Oregon Medicaid market. Adm Policy Ment Health. 2006;33:39–42.PubMedCrossRef

37.

Casalino L, Gillies RR, Shortell SM, et al. External incentives, information technology, and organized processes to improve health care quality for patients with chronic diseases. JAMA. 2003;289:434–41.PubMedCrossRef

38.

Rittenhouse DR, Robinson JC. Improving quality in Medicaid: The use of care management processes for chronic illness and preventive care. Med Care. 2006;44:47–54.PubMedCrossRef

39.

The California Medi-Cal Type 2 Diabetes Study Group. Closing the gap: Effect of diabetes case management on glycemic control among low-income ethnic minority populations. Diabetes Care. 2004;27:95–103.CrossRef

40.

Grazier KL, Hegedus AM, Carli T, Neal D, Reynolds K. Integration of behavioral and physical health care for a Medicaid population through a public-public partnership. Psychiatr Serv. 2003;54:1508–12.PubMedCrossRef

41.

Klein J. Use of Medi-Cal managed care encounter data for research purposes. Sacramento, CA: California Department of Health Services; January, 2002.

42.

Salsberry PJ, Chipps E, Kennedy C. Use of general medical services among Medicaid patients with severe and persistent mental illness. Psychiatr Serv. 2005;56:458–62.PubMedCrossRef

43.

Moos RH, Nichol AC, Moos BS. Global Assessment of Functioning ratings and the allocation and outcomes of mental health services. Psychiatr Serv. 2002;53:730–7.PubMedCrossRef

44.

Frank RG, Glied S. Changes in mental health financing since 1971: Implications for policymakers and patients. Health Aff (Millwood). 2006;25:601–13.CrossRef

Title: Retrospective Analysis of Diabetes Care in California Medicaid Patients with Mental Illness
Authors: Jim E. Banta, PhD, MPH
Elaine H. Morrato, DrPH, MPH
Scott W. Lee, MD
Mark G. Haviland, PhD
Publication date: 01-07-2009
Publisher: Springer-Verlag
Published in: Journal of General Internal Medicine / Issue 7/2009
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-009-0994-9

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Design

Subjects

Measurements

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 7/2009

Primary Care Physicians Treat Somatization

Association Between Prior Experiences of Discrimination and Patients’ Attitudes Towards Health Care Providers Collecting Information About Race and Ethnicity

Activation and Perceived Expectancies: Correlations with Health Outcomes Among Veterans with Inflammatory Bowel Disease

FUO and Biopsy-Negative GCA

High Quality Care and Ethical Pay-for-Performance: A Society of General Internal Medicine Policy Analysis

Filling the Gap: The Importance of Medicaid Continuity for Former Inmates

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials