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Quality of care for cardiovascular disease-related conditions in patients with and without mental disorders.

Kilbourne AM, Welsh D, McCarthy JF, Post EP, Blow FC. Quality of care for cardiovascular disease-related conditions in patients with and without mental disorders. Journal of general internal medicine. 2008 Oct 1; 23(10):1628-33.

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OBJECTIVE: We compared the quality of care for cardiovascular disease (CVD)-related risk factors for patients diagnosed with and without mental disorders. METHODS: We identified all patients included in the fiscal year 2005 (FY05) VA External Peer Review Program's (EPRP) national random sample of chart reviews for assessing quality of care for CVD-related conditions. Using the VA's National Psychosis Registry and the National Registry for Depression, we assessed whether patients had received diagnoses of serious mental illness (schizophrenia, bipolar disorder, or other psychoses) or depression during FY05. Using multivariable logistic regression and generalized estimating equation analyses, we assessed patient and facility factors associated with receipt of guideline concordant care for hypertension (total N = 24,016), hyperlipidemia (N = 46,430), and diabetes (N = 10,943). RESULTS: Overall, 70% had good blood pressure control, 90% received a cholesterol (hyperlipidemia) screen, 77% received a retinal exam for diabetes, and 63% received recommended renal tests for diabetes. After adjustment, compared to patients without SMI or depression, patients with SMI were less likely to be assessed for CVD risk factors, notably hyperlipidemia (OR = 0.58; p < 0.001), and less likely to receive recommended follow-up assessments for diabetes: foot exam (OR = 0.68; p < 0.001), retinal exam (OR = 0.65; p < 0.001), or renal testing (OR = 0.64; p < 0.001). Patients with depression were also significantly less likely to receive adequate quality of care compared to non-psychiatric patients, although effects were smaller than those observed for patients with SMI. CONCLUSIONS: Quality of care for major chronic conditions associated with premature CVD-related mortality is suboptimal for VA patients with SMI, especially for procedures requiring care by a specialist.

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