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Published Online: 20 November 2019

Antipsychotic Medication Adherence and Diabetes-Related Hospitalizations Among Medicaid Recipients With Diabetes and Schizophrenia

Abstract

Objective:

This cross-sectional study examined the relationship between antipsychotic medication adherence and preventable diabetes-related hospitalizations for individuals with diabetes and schizophrenia.

Methods:

Hospitalizations related to diabetes, an ambulatory care sensitive condition, were assessed among Medicaid recipients in New York State with comorbid diabetes and schizophrenia (N=14,365) for three levels of antipsychotic medication adherence: very low to no engagement (two or fewer prescriptions or none in first 6 months), moderate to low adherence, and adherent (proportion of days covered ≥80%).

Results:

Rates of preventable diabetes hospitalization were highest among individuals with very low to no engagement in antipsychotic treatment (4.7%), followed by those with moderate to low adherence (3.3%). Diabetes hospitalizations among adherent individuals were comparable with those of the total diabetes population (both 2.0%). The odds of a preventable diabetes hospitalization were significantly higher among individuals with very low to no engagement in antipsychotic treatment (adjusted odds ratio [AOR]=2.42) and among those with moderate to low adherence (AOR=1.57) than among adherent individuals. Black individuals were also at increased risk of a preventable diabetes hospitalization after the analyses adjusted for antipsychotic adherence and other variables (AOR=1.38).

Conclusions:

This study indicates a relationship between antipsychotic adherence and improved diabetes outcomes among individuals with schizophrenia. Engagement in mental health treatment may be a critical path toward improving health disparities for individuals with schizophrenia. Individuals with very low to no engagement were a particularly vulnerable group, and the exclusion of persons with less than two prescriptions from research and quality measures should be revisited.

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Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Pages: 236 - 242
PubMed: 31744428

History

Received: 8 November 2018
Revision received: 12 August 2019
Accepted: 23 August 2019
Published online: 20 November 2019
Published in print: March 01, 2020

Keywords

  1. Antipsychotic
  2. Medication adherence
  3. Medicaid
  4. Diabetes
  5. Schizophrenia
  6. Ambulatory care sensitive condition

Authors

Details

Katie Egglefield, M.P.H.
Office of Quality and Patient Safety, New York State Department of Health, Albany (Egglefield, Cogan); School of Public Health, State University of New York at Albany, Rensselaer (Cogan, Leckman-Westin); New York State Office of Mental Health, Albany (Leckman-Westin) and New York (Finnerty); New York University Langone Health, New York (Finnerty).
Lindsay Cogan, Ph.D. [email protected]
Office of Quality and Patient Safety, New York State Department of Health, Albany (Egglefield, Cogan); School of Public Health, State University of New York at Albany, Rensselaer (Cogan, Leckman-Westin); New York State Office of Mental Health, Albany (Leckman-Westin) and New York (Finnerty); New York University Langone Health, New York (Finnerty).
Emily Leckman-Westin, Ph.D.
Office of Quality and Patient Safety, New York State Department of Health, Albany (Egglefield, Cogan); School of Public Health, State University of New York at Albany, Rensselaer (Cogan, Leckman-Westin); New York State Office of Mental Health, Albany (Leckman-Westin) and New York (Finnerty); New York University Langone Health, New York (Finnerty).
Molly Finnerty, M.D.
Office of Quality and Patient Safety, New York State Department of Health, Albany (Egglefield, Cogan); School of Public Health, State University of New York at Albany, Rensselaer (Cogan, Leckman-Westin); New York State Office of Mental Health, Albany (Leckman-Westin) and New York (Finnerty); New York University Langone Health, New York (Finnerty).

Notes

Send correspondence to Dr. Cogan ([email protected]).

Author Contributions

All authors contributed equally to this article.

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