The Role of Clinical Setting and Management Approach in Metabolic Testing Among Youths and Adults Treated With Antipsychotics
Abstract
Objective:
Methods:
Results:
Conclusions:
Methods
Results
Testing rate | Regression analysis | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Total | Glucose test | Lipid test | Glucose test | Lipid test | ||||||
Characteristic | N | % | N | %b | N | %b | AOR | 95% CI | AOR | 95% CI |
Youths | 4,271 | 100.0 | 1,582 | 37.0 | 741 | 17.3 | ||||
Care environment | ||||||||||
CMHC plus case management | 578 | 13.5 | 270 | 46.7 | 165 | 28.5 | 1.68 | 1.37–2.04 | 2.40 | 1.91–3.02 |
CMHC only | 961 | 22.5 | 472 | 49.1 | 260 | 27.1 | 1.89 | 1.61–2.22 | 2.35 | 1.94–2.85 |
Neither (reference) | 2,732 | 64.0 | 840 | 30.7 | 316 | 11.6 | ||||
Female | 1,665 | 39.0 | 713 | 42.8 | 306 | 18.4 | 1.33 | 1.15–1.52 | 1.13 | .94–1.34 |
Age at receipt of index prescription | ||||||||||
<6 (reference) | 497 | 11.6 | 153 | 30.8 | 63 | 12.7 | ||||
6–12 | 1,758 | 41.2 | 560 | 31.9 | 315 | 17.9 | 1.04 | .83–1.31 | 1.35 | .99–1.84 |
13–18 | 2,016 | 47.2 | 869 | 43.1 | 363 | 18.0 | 1.80 | 1.42–2.28 | 1.58 | 1.15–2.19 |
Race | ||||||||||
White | 3,263 | 76.4 | 1,260 | 38.6 | 557 | 17.1 | 1.19 | 1.01–1.40 | .78 | .64–.95 |
Other or unknown (reference) | 1,008 | 23.6 | 322 | 31.9 | 184 | 18.3 | ||||
Mental health diagnoses | ||||||||||
0 (reference) | 442 | 10.3 | 123 | 27.8 | 47 | 10.6 | ||||
1 | 1,154 | 27.0 | 377 | 32.7 | 152 | 13.2 | .99 | .76–1.27 | .94 | .66–1.36 |
2 | 1,146 | 26.8 | 434 | 37.9 | 194 | 16.9 | 1.00 | .77–1.29 | 1.04 | .73–1.51 |
≥3 | 1,529 | 35.8 | 648 | 42.4 | 348 | 22.8 | .88 | .67–1.15 | 1.21 | .84–1.76 |
Diabetes | 83 | 1.9 | 54 | 65.1 | 28 | 33.7 | na | na | ||
Dyslipidemia | 31 | .7 | 20 | 64.5 | 13 | 41.9 | na | na | ||
Hypertension | 661 | 15.5 | 258 | 39.0 | 127 | 19.2 | 1.08 | .90–1.30 | 1.07 | .85–1.34 |
Heart disease | 369 | 8.6 | 182 | 49.3 | 74 | 20.1 | 1.34 | 1.06–1.70 | 1.14 | .85–1.53 |
Antipsychotic days supplied | ||||||||||
<120 (reference) | 1,648 | 38.6 | 450 | 27.3 | 126 | 7.6 | ||||
120–239 | 943 | 22.1 | 366 | 38.8 | 169 | 17.9 | 1.78 | 1.49–2.13 | 2.60 | 2.02–3.35 |
≥240 | 1,680 | 39.3 | 766 | 45.6 | 446 | 26.5 | 2.55 | 2.18–3.00 | 4.28 | 3.44–5.37 |
Emergency department claims | ||||||||||
0 (reference) | 2,020 | 47.3 | 683 | 33.8 | 356 | 17.6 | ||||
1–3 | 1,216 | 28.5 | 454 | 37.3 | 213 | 17.5 | 1.11 | .95–1.30 | 1.01 | .83–1.23 |
≥4 | 1,035 | 24.2 | 445 | 43.0 | 172 | 16.6 | 1.18 | .99–1.40 | .88 | .70–1.09 |
Outpatient claims | ||||||||||
0 (reference) | 994 | 23.3 | 305 | 30.7 | 160 | 16.1 | ||||
1–3 | 1,641 | 38.4 | 575 | 35.0 | 284 | 17.3 | 1.16 | .97–1.39 | 1.06 | .85–1.34 |
≥4 | 1,636 | 38.3 | 702 | 42.9 | 297 | 18.2 | 1.52 | 1.27–1.83 | 1.12 | .88–1.41 |
Inpatient claim | 1,230 | 28.8 | 585 | 47.6 | 283 | 23.0 | 1.63 | 1.39–1.92 | 1.29 | 1.05–1.57 |
Antidepressant claim | 1,283 | 30.0 | 552 | 43.0 | 267 | 20.8 | 1.01 | .86–1.17 | 1.11 | .91–1.34 |
Mood stabilizer claim | 629 | 14.7 | 317 | 50.4 | 142 | 22.6 | 1.50 | 1.24–1.80 | 1.15 | .92–1.44 |
Benzodiazepine claim | 168 | 3.9 | 78 | 46.4 | 20 | 11.9 | na | na | ||
Other psychotropic claim | 65 | 1.5 | 32 | 49.2 | 12 | 18.5 | na | na | ||
Adults | 5,202 | 100.0 | 3,572 | 68.7 | 1817 | 34.9 | ||||
Care environment | ||||||||||
CMHC plus case management | 781 | 15.0 | 592 | 75.8 | 377 | 48.3 | 1.43 | 1.18–1.74 | 1.97 | 1.64–2.36 |
CMHC only | 1,113 | 21.4 | 832 | 74.8 | 444 | 39.9 | 1.44 | 1.22–1.70 | 1.48 | 1.27–1.74 |
Neither (reference) | 3,308 | 63.6 | 2,148 | 64.9 | 996 | 30.1 | ||||
Female | 3,758 | 72.2 | 2,568 | 68.3 | 1,262 | 33.6 | 1.09 | .93–1.26 | .98 | .84–1.13 |
Age at receipt of index prescription | ||||||||||
19–29 (reference) | 1,772 | 34.1 | 1,046 | 59.0 | 337 | 19.0 | ||||
30–39 | 1,378 | 26.5 | 887 | 64.4 | 456 | 33.1 | 1.06 | .91–1.25 | 1.59 | 1.33–1.90 |
40–49 | 1,164 | 22.4 | 911 | 78.3 | 555 | 47.7 | 1.69 | 1.40–2.05 | 2.09 | 1.73–2.53 |
≥50 | 888 | 17.1 | 728 | 82.0 | 469 | 52.8 | 1.85 | 1.46–2.34 | 2.11 | 1.70–2.61 |
Race | ||||||||||
White | 4,103 | 78.9 | 2,827 | 68.9 | 1,393 | 34.0 | 1.09 | .93–1.29 | .85 | .73–1.00 |
Other or unknown (reference) | 1,099 | 21.1 | 745 | 67.8 | 424 | 38.6 | ||||
Mental health diagnoses | ||||||||||
0 (reference) | 486 | 9.3 | 281 | 57.8 | 120 | 24.7 | ||||
1 | 1,220 | 23.5 | 800 | 65.6 | 423 | 34.7 | 1.05 | .83–1.33 | 1.21 | .93–1.58 |
2 | 1,570 | 30.2 | 1,058 | 67.4 | 561 | 35.7 | .99 | .78–1.25 | 1.23 | .95–1.61 |
≥3 | 1,926 | 37.0 | 1,433 | 74.4 | 713 | 37.0 | 1.17 | .91–1.50 | 1.27 | .97–1.66 |
Diabetes | 1,001 | 19.2 | 840 | 83.9 | 551 | 55.0 | 1.51 | 1.23–1.85 | 1.42 | 1.20–1.68 |
Dyslipidemia | 1,285 | 24.7 | 1,064 | 82.8 | 786 | 61.2 | 1.41 | 1.17–1.71 | 2.58 | 2.20–3.02 |
Hypertension | 2,192 | 42.1 | 1,736 | 79.2 | 1,060 | 48.4 | 1.30 | 1.12–1.52 | 1.44 | 1.24–1.67 |
Heart disease | 1,867 | 35.9 | 1,474 | 79.0 | 795 | 42.6 | 1.25 | 1.07–1.47 | 1.06 | .91–1.24 |
Antipsychotic days supplied | ||||||||||
<120 (reference) | 2,639 | 50.7 | 1,598 | 60.6 | 679 | 25.7 | ||||
120–239 | 1,081 | 20.8 | 772 | 71.4 | 397 | 36.7 | 1.56 | 1.33–1.84 | 1.56 | 1.32–1.84 |
≥240 | 1,482 | 28.5 | 1,202 | 81.1 | 741 | 50.0 | 2.52 | 2.15–2.97 | 2.44 | 2.11–2.83 |
Emergency department claims | ||||||||||
0 (reference) | 1,434 | 27.6 | 927 | 64.6 | 539 | 37.6 | ||||
1–4 | 1,483 | 28.5 | 939 | 63.3 | 465 | 31.4 | .97 | .83–1.15 | .85 | .71–1.01 |
5–9 | 1,076 | 20.7 | 755 | 70.2 | 380 | 35.3 | 1.26 | 1.04–1.52 | 1.01 | .83–1.22 |
≥10 | 1,209 | 23.2 | 951 | 78.7 | 433 | 35.8 | 1.68 | 1.36–2.07 | .96 | .78–1.18 |
Outpatient claims | ||||||||||
0 (reference) | 831 | 16.0 | 466 | 56.1 | 227 | 27.3 | ||||
1–4 | 1,754 | 33.7 | 1,126 | 64.2 | 535 | 30.5 | 1.30 | 1.09–1.56 | 1.09 | .89–1.33 |
5–9 | 1,312 | 25.2 | 945 | 72.0 | 500 | 38.1 | 1.66 | 1.35–2.04 | 1.35 | 1.09–1.68 |
≥10 | 1,305 | 25.1 | 1035 | 79.3 | 555 | 42.5 | 1.89 | 1.51–2.38 | 1.31 | 1.04–1.65 |
Inpatient claims | ||||||||||
0 (reference) | 3,147 | 60.5 | 2,059 | 65.4 | 1,100 | 35.0 | ||||
1 | 1,233 | 23.7 | 863 | 70.0 | 411 | 33.3 | 1.11 | .95–1.30 | .92 | .78–1.09 |
≥2 | 822 | 15.8 | 650 | 79.1 | 306 | 37.2 | 1.26 | 1.02–1.57 | .80 | .65–.98 |
Antidepressant claim | 3,627 | 69.7 | 2,595 | 71.5 | 1,364 | 37.6 | 1.01 | .87–1.18 | .98 | .83–1.14 |
Mood stabilizer claim | 1,187 | 22.8 | 873 | 73.5 | 467 | 39.3 | 1.17 | 1.00–1.37 | 1.12 | .96–1.31 |
Benzodiazepine claim | 2,498 | 48.0 | 1,792 | 71.7 | 917 | 36.7 | .81 | .70-.94 | .80 | .69–.92 |
Other psychotropic claim | 546 | 10.5 | 405 | 74.2 | 225 | 41.2 | .96 | .77–1.20 | 1.03 | .84–1.27 |
Discussion and Conclusions
Acknowledgments
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