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Continuity of medication management in Medicaid patients with chronic comorbid conditions: An examination by mental health status.

Farley JF, Hansen RA, Domino ME, Borse M, Mahendraratnam N, Ray N, Maciejewski ML. Continuity of medication management in Medicaid patients with chronic comorbid conditions: An examination by mental health status. General hospital psychiatry. 2017 Mar 1; 45:25-31.

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OBJECTIVE: Patients with serious mental illness (SMI) often have comorbid cardiometabolic conditions (CMCs) that may increase the number of prescribers involved in treatment. This study examined whether patients with SMI (depression and schizophrenia) and comorbid CMCs experience greater discontinuity of prescribing than patients with CMCs alone. METHODS: 2009 Medicaid data were used to compare number and types of prescribers (primary care, cardiometabolic, psychiatric, other) in individuals with 1-3 CMCs (diabetes, hypertension, dyslipidemia) alone (n = 76.451); with CMC and schizophrenia (n = 6507); and with CMC and depression (n = 23.510) and the degree of prescribing within a provider's area of specialty. RESULTS: 44%, 61%, and 71% of individuals with CMCs only, with CMCs and schizophrenia, and with CMCs and depression had medications from these classes prescribed by 5 or more providers respectively. > 35% of patients with CMCs alone or CMCs and schizophrenia had prescriptions provided by 3 or more PCP providers, which increased to 49.1% for patients with CMCs and depression. In the schizophrenia cohort, 29% of antipsychotics were PCP-prescribed while psychiatrists prescribed 10%, 9%, and 9% of antihypertensive, antihyperlipidemic, and antidiabetic medications respectively. CONCLUSIONS: The presence of SMI increases the number of prescribers treating individuals with CMCs. The impact of this fragmentation in medication management on health outcomes is unknown.

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