Retrospective Analysis of Diabetes Care in California Medicaid Patients with Mental Illness
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 mo...
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| Veröffentlicht in: | Journal of general internal medicine : JGIM 2009-07, Vol.24 (7), p.802-808 |
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| container_title | Journal of general internal medicine : JGIM |
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| creator | Banta, Jim E. Morrato, Elaine H. Lee, Scott W. Haviland, Mark G. |
| description | 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. |
| doi_str_mv | 10.1007/s11606-009-0994-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_2695534</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>733227326</sourcerecordid><originalsourceid>FETCH-LOGICAL-c498t-ab8f3c6d8f3476cb78f1a49d145adb8a6340574ba2b80572ede013549addd0793</originalsourceid><addsrcrecordid>eNp1kV1rFDEUhoNY7Lb6A7yRQZBejeZrJsmNULZVCxVF9MqLcCbJtCnZzJozW-m_b5ZdWhW8yQk5T97z8RLyktG3jFL1Dhnrad9SalpqjGzNE7JgHe9aJo16ShZUa9lqJeQhOUK8oZQJzvUzcsiMZJ0wbEF-fgtzmXAd3BxvQ3OaId1hxGYam7MIQ5gDNksooYm5xhTHqeQIzefgo4Pom68wx5BnbH7H-bo-5xlSc5FSDojPycEICcOLfTwmPz6cf19-ai-_fLxYnl62Tho9tzDoUbje11Oq3g1Kjwyk8Ux24AcNvZC0U3IAPuh64cGHOkgnDXjvqTLimLzf6a43wyp4V5sokOy6xBWUOztBtH9ncry2V9Ot5b3pOiGrwMleoEy_NgFnu4roQkqQw7RBq0TdmxK8r-Trf8ibaVPq0tBq1QvKtd5CbAe5ulksYXxohVG7Nc7ujLPVOLs1zm5nePXnDI8_9k5V4M0eAHSQxgLZRXzgOOe9VJRXju84rKl8Fcpjh_-vfg9uTbFE</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>876302886</pqid></control><display><type>article</type><title>Retrospective Analysis of Diabetes Care in California Medicaid Patients with Mental Illness</title><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><source>SpringerLink Journals - AutoHoldings</source><creator>Banta, Jim E. ; Morrato, Elaine H. ; Lee, Scott W. ; Haviland, Mark G.</creator><creatorcontrib>Banta, Jim E. ; Morrato, Elaine H. ; Lee, Scott W. ; Haviland, Mark G.</creatorcontrib><description>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.</description><identifier>ISSN: 0884-8734</identifier><identifier>EISSN: 1525-1497</identifier><identifier>DOI: 10.1007/s11606-009-0994-9</identifier><identifier>PMID: 19415391</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Adolescent ; Adult ; Biological and medical sciences ; California - epidemiology ; Diabetes ; Diabetes Mellitus - drug therapy ; Diabetes Mellitus - epidemiology ; Diabetes Mellitus - therapy ; Diabetes. Impaired glucose tolerance ; Disease management ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Female ; General aspects ; Health Services Research ; Humans ; Internal Medicine ; Logistic Models ; Male ; Medicaid ; Medical sciences ; Medicine ; Medicine & Public Health ; Mental Disorders ; Mental Health ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Original ; Original Article ; Psychology. Psychoanalysis. Psychiatry ; Psychopathology. Psychiatry ; Quality of care ; Retrospective Studies ; Risk Factors ; Statistics as Topic ; United States - epidemiology ; Young Adult</subject><ispartof>Journal of general internal medicine : JGIM, 2009-07, Vol.24 (7), p.802-808</ispartof><rights>Society of General Internal Medicine 2009</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c498t-ab8f3c6d8f3476cb78f1a49d145adb8a6340574ba2b80572ede013549addd0793</citedby><cites>FETCH-LOGICAL-c498t-ab8f3c6d8f3476cb78f1a49d145adb8a6340574ba2b80572ede013549addd0793</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695534/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2695534/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27922,27923,41486,42555,51317,53789,53791</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22264702$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19415391$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Banta, Jim E.</creatorcontrib><creatorcontrib>Morrato, Elaine H.</creatorcontrib><creatorcontrib>Lee, Scott W.</creatorcontrib><creatorcontrib>Haviland, Mark G.</creatorcontrib><title>Retrospective Analysis of Diabetes Care in California Medicaid Patients with Mental Illness</title><title>Journal of general internal medicine : JGIM</title><addtitle>J GEN INTERN MED</addtitle><addtitle>J Gen Intern Med</addtitle><description>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.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>California - epidemiology</subject><subject>Diabetes</subject><subject>Diabetes Mellitus - drug therapy</subject><subject>Diabetes Mellitus - epidemiology</subject><subject>Diabetes Mellitus - therapy</subject><subject>Diabetes. Impaired glucose tolerance</subject><subject>Disease management</subject><subject>Endocrine pancreas. Apud cells (diseases)</subject><subject>Endocrinopathies</subject><subject>Etiopathogenesis. Screening. Investigations. Target tissue resistance</subject><subject>Female</subject><subject>General aspects</subject><subject>Health Services Research</subject><subject>Humans</subject><subject>Internal Medicine</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medicaid</subject><subject>Medical sciences</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mental Disorders</subject><subject>Mental Health</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Odds Ratio</subject><subject>Original</subject><subject>Original Article</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. Psychiatry</subject><subject>Quality of care</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Statistics as Topic</subject><subject>United States - epidemiology</subject><subject>Young Adult</subject><issn>0884-8734</issn><issn>1525-1497</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp1kV1rFDEUhoNY7Lb6A7yRQZBejeZrJsmNULZVCxVF9MqLcCbJtCnZzJozW-m_b5ZdWhW8yQk5T97z8RLyktG3jFL1Dhnrad9SalpqjGzNE7JgHe9aJo16ShZUa9lqJeQhOUK8oZQJzvUzcsiMZJ0wbEF-fgtzmXAd3BxvQ3OaId1hxGYam7MIQ5gDNksooYm5xhTHqeQIzefgo4Pom68wx5BnbH7H-bo-5xlSc5FSDojPycEICcOLfTwmPz6cf19-ai-_fLxYnl62Tho9tzDoUbje11Oq3g1Kjwyk8Ux24AcNvZC0U3IAPuh64cGHOkgnDXjvqTLimLzf6a43wyp4V5sokOy6xBWUOztBtH9ncry2V9Ot5b3pOiGrwMleoEy_NgFnu4roQkqQw7RBq0TdmxK8r-Trf8ibaVPq0tBq1QvKtd5CbAe5ulksYXxohVG7Nc7ujLPVOLs1zm5nePXnDI8_9k5V4M0eAHSQxgLZRXzgOOe9VJRXju84rKl8Fcpjh_-vfg9uTbFE</recordid><startdate>20090701</startdate><enddate>20090701</enddate><creator>Banta, Jim E.</creator><creator>Morrato, Elaine H.</creator><creator>Lee, Scott W.</creator><creator>Haviland, Mark G.</creator><general>Springer-Verlag</general><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20090701</creationdate><title>Retrospective Analysis of Diabetes Care in California Medicaid Patients with Mental Illness</title><author>Banta, Jim E. ; Morrato, Elaine H. ; Lee, Scott W. ; Haviland, Mark G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c498t-ab8f3c6d8f3476cb78f1a49d145adb8a6340574ba2b80572ede013549addd0793</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>California - epidemiology</topic><topic>Diabetes</topic><topic>Diabetes Mellitus - drug therapy</topic><topic>Diabetes Mellitus - epidemiology</topic><topic>Diabetes Mellitus - therapy</topic><topic>Diabetes. Impaired glucose tolerance</topic><topic>Disease management</topic><topic>Endocrine pancreas. Apud cells (diseases)</topic><topic>Endocrinopathies</topic><topic>Etiopathogenesis. Screening. Investigations. Target tissue resistance</topic><topic>Female</topic><topic>General aspects</topic><topic>Health Services Research</topic><topic>Humans</topic><topic>Internal Medicine</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medicaid</topic><topic>Medical sciences</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mental Disorders</topic><topic>Mental Health</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Odds Ratio</topic><topic>Original</topic><topic>Original Article</topic><topic>Psychology. Psychoanalysis. Psychiatry</topic><topic>Psychopathology. Psychiatry</topic><topic>Quality of care</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Statistics as Topic</topic><topic>United States - epidemiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Banta, Jim E.</creatorcontrib><creatorcontrib>Morrato, Elaine H.</creatorcontrib><creatorcontrib>Lee, Scott W.</creatorcontrib><creatorcontrib>Haviland, Mark G.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of general internal medicine : JGIM</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Banta, Jim E.</au><au>Morrato, Elaine H.</au><au>Lee, Scott W.</au><au>Haviland, Mark G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Retrospective Analysis of Diabetes Care in California Medicaid Patients with Mental Illness</atitle><jtitle>Journal of general internal medicine : JGIM</jtitle><stitle>J GEN INTERN MED</stitle><addtitle>J Gen Intern Med</addtitle><date>2009-07-01</date><risdate>2009</risdate><volume>24</volume><issue>7</issue><spage>802</spage><epage>808</epage><pages>802-808</pages><issn>0884-8734</issn><eissn>1525-1497</eissn><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.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>19415391</pmid><doi>10.1007/s11606-009-0994-9</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0884-8734 |
| ispartof | Journal of general internal medicine : JGIM, 2009-07, Vol.24 (7), p.802-808 |
| issn | 0884-8734 1525-1497 |
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| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; PubMed Central; Alma/SFX Local Collection; SpringerLink Journals - AutoHoldings |
| subjects | Adolescent Adult Biological and medical sciences California - epidemiology Diabetes Diabetes Mellitus - drug therapy Diabetes Mellitus - epidemiology Diabetes Mellitus - therapy Diabetes. Impaired glucose tolerance Disease management Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Female General aspects Health Services Research Humans Internal Medicine Logistic Models Male Medicaid Medical sciences Medicine Medicine & Public Health Mental Disorders Mental Health Middle Aged Multivariate Analysis Odds Ratio Original Original Article Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Quality of care Retrospective Studies Risk Factors Statistics as Topic United States - epidemiology Young Adult |
| title | Retrospective Analysis of Diabetes Care in California Medicaid Patients with Mental Illness |
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