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Retrospective Analysis of Diabetes Care in California Medicaid Patients with Mental Illness

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Abstract

Background

Serious mental illness often is associated with an increased risk of diabetes and sub-optimal diabetes care.

Objective

To examine diabetes prevalence and care among Medicaid patients from one county mental health system.

Design

Retrospective cohort study combining county records and 12 months of state Medicaid claims.

Subjects

Patients ages 18 to 59 receiving mental health services between November 1 and 14, 2004.

Measurements

Dependent variables were glycolated hemoglobin A1C (HbA1c) testing, lipid testing, and eye examinations. Psychiatric status was assessed by second generation antipsychotic prescription (SGA) and low Global Assessment of Functioning (GAF) score.

Results

Among psychiatric patients, 482 (11.8%) had diabetes. Among those with diabetes, 47.3% received annual HbA1c testing, 56.0% lipid testing, and 31.7% eye examinations. Low GAF scores were associated with lower likelihood of lipid testing (OR 0.43). SGA prescription reduced the likelihood of HbA1c testing (OR 0.58) but increased the likelihood of eye examinations (OR 2.02). Primary care visits were positively associated with HbA1c and lipid testing (ORs 5.01 and 2.21, respectively). Patients seen by a fee-for-service psychiatrist were more likely to have lipid testing (OR 2.35) and eye examinations (OR 2.03).

Conclusion

Among Medicaid psychiatric patients, worse diabetes care was associated with SGA prescription, more serious psychiatric symptoms, and receiving psychiatric care only in public mental health clinics. Diabetes care improved when patients were seen by fee-for-service psychiatrists or primary care physicians. Further study is needed to identify methods for improving diabetes care of public mental health patients.

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Acknowledgements

This research was supported, in part, by a seed grant from the Loma Linda University School of Public Health Center for Health Research.

Conflict of Interest

None of the authors, Jim E. Banta, Elaine H. Morrato, Scott W. Lee, and Mark G. Haviland report a conflict of interest. There was no external funding; the internal seed grant was used to purchase the state Medicaid data. None of the authors receives funding directly from either the State Department of Health Services or the County of San Bernardino.

Author information

Authors and Affiliations

  1. Department of Health Policy and Management, School of Public Health, Loma Linda University, 24951 North Circle Drive, Loma Linda, CA, 92350, USA

    Jim E. Banta PhD, MPH

  2. Department of Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado, Denver, USA

    Elaine H. Morrato DrPH, MPH

  3. Department of Internal Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA

    Scott W. Lee MD

  4. Department of Psychiatry, School of Medicine, Loma Linda University, Loma Linda, CA, USA

    Mark G. Haviland PhD

  5. Department of Epidemiology and Biostatistics, School of Public Health, Loma Linda University, 24951 North Circle Drive, Loma Linda, CA, 92350, USA

    Jim E. Banta PhD, MPH

  6. Department of Clinical Pharmacy, School of Pharmacy, University of Colorado, Denver, USA

    Elaine H. Morrato DrPH, MPH

Authors
  1. Jim E. Banta PhD, MPH
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  2. Elaine H. Morrato DrPH, MPH
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  3. Scott W. Lee MD
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  4. Mark G. Haviland PhD
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Corresponding author

Correspondence to Jim E. Banta PhD, MPH.

Additional information

Portions of this work were presented June 2007 at the AcademyHealth Annual Research Meeting in Orlando, Florida and November 2007 at the American Public Health Association’s 135th Annual Meeting, in Washington, DC. (PowerPoint file for the latter posted on APHA website.)

Partial funding for this project was provided by a seed grant from the Loma Linda University School of Public Health Center for Health Research.

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Banta, J.E., Morrato, E.H., Lee, S.W. et al. Retrospective Analysis of Diabetes Care in California Medicaid Patients with Mental Illness. J GEN INTERN MED 24, 802–808 (2009). https://doi.org/10.1007/s11606-009-0994-9

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  • DOI: https://doi.org/10.1007/s11606-009-0994-9

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