, Volume 24, Issue 7, pp 802-808

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

Purchase on Springer.com

$39.95 / €34.95 / £29.95*

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

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.

Portions of this work were presented June 2007 at the AcademyHealth Annual Research Meeting in Orlando, Florida and November 2007 at the American Public Health Association’s 135th Annual Meeting, in Washington, DC. (PowerPoint file for the latter posted on APHA website.)
Partial funding for this project was provided by a seed grant from the Loma Linda University School of Public Health Center for Health Research.