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

Richard A. Hansen, Natalie Hohmann, Matthew L. Maciejewski, Marisa E. Domino, Neepa Ray, Nirosha Mahendraratnam, Joel F Farley

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)13-20
Number of pages8
JournalJournal of Pharmaceutical Health Services Research
Volume9
Issue number1
DOIs
StatePublished - Mar 2018

Bibliographical note

Funding Information:
This work was supported by the Agency for Healthcare Research and Quality (Grant Number: 1R01HS023099-01).

Publisher Copyright:
© 2017 Royal Pharmaceutical Society

Copyright:
Copyright 2018 Elsevier B.V., All rights reserved.

Keywords

  • care coordination
  • chronic conditions
  • health services outcome
  • schizophrenia

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