Continuity of medication management among adults with schizophrenia and comorbid cardiometabolic conditions

Objectives: Adults with schizophrenia and cardiometabolic conditions (CMCs) may be good candidates for comanagement by primary care prescribers (PCPs) and specialists. Associated risks for discontinuity in medication management have not been well studied. This study examines whether medication adherence, inpatient admissions and emergency department (ED) visits vary by the number and types of prescribers seen by adults with schizophrenia and CMCs. Methods: This study used a retrospective cohort of 4223 adult Medicaid enrollees with schizophrenia and hypertension, hyperlipidemia and/or diabetes from three states in 2009–2010. Logistic regression models were run on outcome variables reflecting medication adherence, ED utilization and inpatient admissions as a function of the number and types of prescribers. Key findings: Increases in number of psychiatric specialists were associated with better antipsychotic adherence, but decreasing statin adherence. Increases in number of psychiatric specialists were also associated with a higher probability of inpatient admission and ED visits, while increases in number of PCPs were associated with increases in the probability of ED visits. Conclusions: Greater antipsychotic adherence for adults receiving prescriptions from multiple psychiatric specialists was counteracted by lower statin adherence and greater risk of ED and inpatient utilization. This may help inform optimal care models for these complex individuals.