Antipsychotic medication adherence and preventive diabetes screening in Medicaid enrollees with serious mental illness: an analysis of real-world administrative data
Abstract Background There is excess amenable mortality risk and evidence of healthcare quality deficits for persons with serious mental illness (SMI). We sought to identify sociodemographic and clinical characteristics associated with variations in two 2015 Healthcare Effectiveness Data and Informat...
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| Format: | Article |
| Language: | English |
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BMC
2021-01-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-020-06045-0 |
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| author | Erica L. Stockbridge Nathaniel J. Webb Eleena Dhakal Manasa Garg Abiah D. Loethen Thaddeus L. Miller Karabi Nandy |
| author_facet | Erica L. Stockbridge Nathaniel J. Webb Eleena Dhakal Manasa Garg Abiah D. Loethen Thaddeus L. Miller Karabi Nandy |
| author_sort | Erica L. Stockbridge |
| collection | DOAJ |
| description | Abstract Background There is excess amenable mortality risk and evidence of healthcare quality deficits for persons with serious mental illness (SMI). We sought to identify sociodemographic and clinical characteristics associated with variations in two 2015 Healthcare Effectiveness Data and Information Set (HEDIS) measures, antipsychotic medication adherence and preventive diabetes screening, among Medicaid enrollees with serious mental illness (SMI). Methods We retrospectively analyzed claims data from September 2014 to December 2015 from enrollees in a Medicaid specialty health plan in Florida. All plan enrollees had SMI; analyses included continuously enrolled adults with antipsychotic medication prescriptions and schizophrenia or bipolar disorder. Associations were identified using mixed effects logistic regression models. Results Data for 5502 enrollees were analyzed. Substance use disorders, depression, and having both schizophrenia and bipolar disorder diagnoses were associated with both HEDIS measures but the direction of the associations differed; each was significantly associated with antipsychotic medication non-adherence (a marker of suboptimal care quality) but an increased likelihood of diabetes screening (a marker of quality care). Compared to whites, blacks and Hispanics had a significantly greater risk of medication non-adherence. Increasing age was significantly associated with increasing medication adherence, but the association between age and diabetes screening varied by sex. Other characteristics significantly associated with quality variations according to one or both measures were education (associated with antipsychotic medication adherence), urbanization (relative to urban locales, residing in suburban areas was associated with both adherence and diabetes screening), obesity (associated with both adherence and diabetes screening), language (non-English speakers had a greater likelihood of diabetes screening), and anxiety, asthma, and hypertension (each positively associated with diabetes screening). Conclusions The characteristics associated with variations in the quality of care provided to Medicaid enrollees with SMI as gauged by two HEDIS measures often differed, and at times associations were directionally opposite. The variations in the quality of healthcare received by persons with SMI that were identified in this study can guide quality improvement and delivery system reform efforts; however, given the sociodemographic and clinical characteristics’ differing associations with different measures of care quality, multidimensional approaches are warranted. |
| first_indexed | 2024-12-13T13:10:03Z |
| format | Article |
| id | doaj.art-a701959298b4408cb25c6e2b5a2c7d93 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-13T13:10:03Z |
| publishDate | 2021-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-a701959298b4408cb25c6e2b5a2c7d932022-12-21T23:44:43ZengBMCBMC Health Services Research1472-69632021-01-0121111610.1186/s12913-020-06045-0Antipsychotic medication adherence and preventive diabetes screening in Medicaid enrollees with serious mental illness: an analysis of real-world administrative dataErica L. Stockbridge0Nathaniel J. Webb1Eleena Dhakal2Manasa Garg3Abiah D. Loethen4Thaddeus L. Miller5Karabi Nandy6Department of Advanced Health Analytics and Solutions, Magellan Health, IncDepartment of Health Behavior & Health Systems, School of Public Health, University of North Texas Health Science CenterDepartment of Biostatistics and Epidemiology, School of Public Health, University of North Texas Health Science CenterDepartment of Health Behavior & Health Systems, School of Public Health, University of North Texas Health Science CenterDepartment of Advanced Health Analytics and Solutions, Magellan Health, IncDepartment of Health Behavior & Health Systems, School of Public Health, University of North Texas Health Science CenterDepartment of Population and Data Sciences, UT Southwestern Medical CenterAbstract Background There is excess amenable mortality risk and evidence of healthcare quality deficits for persons with serious mental illness (SMI). We sought to identify sociodemographic and clinical characteristics associated with variations in two 2015 Healthcare Effectiveness Data and Information Set (HEDIS) measures, antipsychotic medication adherence and preventive diabetes screening, among Medicaid enrollees with serious mental illness (SMI). Methods We retrospectively analyzed claims data from September 2014 to December 2015 from enrollees in a Medicaid specialty health plan in Florida. All plan enrollees had SMI; analyses included continuously enrolled adults with antipsychotic medication prescriptions and schizophrenia or bipolar disorder. Associations were identified using mixed effects logistic regression models. Results Data for 5502 enrollees were analyzed. Substance use disorders, depression, and having both schizophrenia and bipolar disorder diagnoses were associated with both HEDIS measures but the direction of the associations differed; each was significantly associated with antipsychotic medication non-adherence (a marker of suboptimal care quality) but an increased likelihood of diabetes screening (a marker of quality care). Compared to whites, blacks and Hispanics had a significantly greater risk of medication non-adherence. Increasing age was significantly associated with increasing medication adherence, but the association between age and diabetes screening varied by sex. Other characteristics significantly associated with quality variations according to one or both measures were education (associated with antipsychotic medication adherence), urbanization (relative to urban locales, residing in suburban areas was associated with both adherence and diabetes screening), obesity (associated with both adherence and diabetes screening), language (non-English speakers had a greater likelihood of diabetes screening), and anxiety, asthma, and hypertension (each positively associated with diabetes screening). Conclusions The characteristics associated with variations in the quality of care provided to Medicaid enrollees with SMI as gauged by two HEDIS measures often differed, and at times associations were directionally opposite. The variations in the quality of healthcare received by persons with SMI that were identified in this study can guide quality improvement and delivery system reform efforts; however, given the sociodemographic and clinical characteristics’ differing associations with different measures of care quality, multidimensional approaches are warranted.https://doi.org/10.1186/s12913-020-06045-0Serious mental illnessMental healthMedication adherenceDiabetes screeningHealthcare qualityMedicaid |
| spellingShingle | Erica L. Stockbridge Nathaniel J. Webb Eleena Dhakal Manasa Garg Abiah D. Loethen Thaddeus L. Miller Karabi Nandy Antipsychotic medication adherence and preventive diabetes screening in Medicaid enrollees with serious mental illness: an analysis of real-world administrative data BMC Health Services Research Serious mental illness Mental health Medication adherence Diabetes screening Healthcare quality Medicaid |
| title | Antipsychotic medication adherence and preventive diabetes screening in Medicaid enrollees with serious mental illness: an analysis of real-world administrative data |
| title_full | Antipsychotic medication adherence and preventive diabetes screening in Medicaid enrollees with serious mental illness: an analysis of real-world administrative data |
| title_fullStr | Antipsychotic medication adherence and preventive diabetes screening in Medicaid enrollees with serious mental illness: an analysis of real-world administrative data |
| title_full_unstemmed | Antipsychotic medication adherence and preventive diabetes screening in Medicaid enrollees with serious mental illness: an analysis of real-world administrative data |
| title_short | Antipsychotic medication adherence and preventive diabetes screening in Medicaid enrollees with serious mental illness: an analysis of real-world administrative data |
| title_sort | antipsychotic medication adherence and preventive diabetes screening in medicaid enrollees with serious mental illness an analysis of real world administrative data |
| topic | Serious mental illness Mental health Medication adherence Diabetes screening Healthcare quality Medicaid |
| url | https://doi.org/10.1186/s12913-020-06045-0 |
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