Open AccessContinuity of medication management among adults with schizophrenia and comorbid cardiometabolic conditions
Author(s) -
Hansen Richard A.,
Hohmann Natalie,
Maciejewski Matthew L.,
Domino Marisa E.,
Ray Neepa,
Mahendraratnam Nirosha,
Farley Joel F.
Publication year - 2018
Publication title -
journal of pharmaceutical health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.244
H-Index - 15
eISSN - 1759-8893
pISSN - 1759-8885
DOI - 10.1111/jphs.12201
Subject(s) - medicine , schizophrenia (object oriented programming) , medicaid , medical prescription , antipsychotic , emergency department , logistic regression , psychiatry , retrospective cohort study , medication adherence , emergency medicine , health care , pharmacology , economics , economic growth
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.