Continuity of medication management in Medicaid patients with chronic comorbid conditions: An examination by mental health status.
OBJECTIVE
Patients with serious mental illness (SMI) often have comorbid cardiometabolic conditions (CMCs) that may increase the number of prescribers involved in treatment. This study examined whether patients with SMI (depression and schizophrenia) and comorbid CMCs experience greater discontinuity of prescribing than patients with CMCs alone.


METHODS
2009 Medicaid data were used to compare number and types of prescribers (primary care, cardiometabolic, psychiatric, other) in individuals with 1-3 CMCs (diabetes, hypertension, dyslipidemia) alone (n=76.451); with CMC and schizophrenia (n=6507); and with CMC and depression (n=23.510) and the degree of prescribing within a provider's area of specialty.


RESULTS
44%, 61%, and 71% of individuals with CMCs only, with CMCs and schizophrenia, and with CMCs and depression had medications from these classes prescribed by 5 or more providers respectively. >35% of patients with CMCs alone or CMCs and schizophrenia had prescriptions provided by 3 or more PCP providers, which increased to 49.1% for patients with CMCs and depression. In the schizophrenia cohort, 29% of antipsychotics were PCP-prescribed while psychiatrists prescribed 10%, 9%, and 9% of antihypertensive, antihyperlipidemic, and antidiabetic medications respectively.


CONCLUSIONS
The presence of SMI increases the number of prescribers treating individuals with CMCs. The impact of this fragmentation in medication management on health outcomes is unknown.
['Farley|Joel F|JF|', 'Hansen|Richard A|RA|', 'Domino|Marisa E|ME|', 'Borse|Mrudula|M|', 'Mahendraratnam|Nirosha|N|', 'Ray|Neepa|N|', 'Maciejewski|Matthew L|ML|']
D000293:Adolescent D000328:Adult D002908:Chronic Disease D015897:Comorbidity D003266:Continuity of Patient Care D003430:Cross-Sectional Studies D003866:Depressive Disorder D003920:Diabetes Mellitus D011307:Drug Prescriptions D005260:Female D006801:Humans D006949:Hyperlipidemias D006973:Hypertension D008297:Male D008484:Medicaid D008875:Middle Aged D012559:Schizophrenia D014481:United States D055815:Young Adult
Mental health Diabetes Hypertension Chronic disease Continuity of care