RESUMEN
Medicaid beneficiaries with schizophrenia and bipolar disorder require a range of services and supports. This descriptive study used 2007 Medicaid claims data from 21 states and the District of Columbia to examine the extent to which this population received guideline-concordant medications, medication monitoring, outpatient mental health care, and preventive physical health care. More than 80 % of beneficiaries in each state filled at least one prescription for a guideline-concordant medication during the year but, on average, only 57 % of those with schizophrenia and 45 % of those with bipolar disorder maintained a continuous supply of medications. Roughly 25 % did not have an outpatient mental health visit during the year (excluding case management and some other services); in some states more than half did not have such a visit. Only 11 % of beneficiaries received a physical health examination or health behavior counseling when claims codes were used to identify these services rather than all primary care physician visits. Less than 5 % of beneficiaries maintained their supply of medications, received medication monitoring and had an outpatient mental health visit, physical health examination or received health behavior counseling during the year. Although these rates of service utilization are likely conservative and the data predate recent efforts to integrate care, the findings underscore the need for quality improvement efforts targeted to this population and may provide a baseline for monitoring progress.
Asunto(s)
Trastorno Bipolar/terapia , Servicios de Salud Mental/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Esquizofrenia/terapia , Adolescente , Adulto , Trastorno Bipolar/tratamiento farmacológico , Servicios de Salud Comunitaria/estadística & datos numéricos , Consejo/estadística & datos numéricos , District of Columbia , Femenino , Conductas Relacionadas con la Salud , Humanos , Masculino , Medicaid , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Examen Físico/estadística & datos numéricos , Calidad de la Atención de Salud/estadística & datos numéricos , Esquizofrenia/tratamiento farmacológico , Estados Unidos , Adulto JovenRESUMEN
OBJECTIVE: This study examined state and demographic variation in use of depot antipsychotics among Medicaid beneficiaries with schizophrenia. METHOD: Medicaid claims data (2007) from 21 states and the District of Columbia were analyzed for 102,884 beneficiaries age 18 to 64 with schizophrenia. Rates of receipt of depot antipsychotics were determined for all beneficiaries and for African Americans, Caucasians, and beneficiaries from "all other races." RESULTS: Across study states, a mean of 10% of beneficiaries with schizophrenia received depot antipsychotics. Rates ranged from 1.9% in the District of Columbia to 20.9% in Alabama. In 12 states, African Americans were disproportionately likely to receive these medications compared with beneficiaries of other races. CONCLUSIONS: Use of depot antipsychotics varied across state Medicaid programs. African Americans received a disproportionate share in many states. Further research is needed to understand the sources of such variation. These findings underscore the need to monitor the use of depot antipsychotics.
Asunto(s)
Antipsicóticos/uso terapéutico , Utilización de Medicamentos/estadística & datos numéricos , Etnicidad/estadística & datos numéricos , Medicaid/estadística & datos numéricos , Esquizofrenia/tratamiento farmacológico , Adolescente , Adulto , Negro o Afroamericano/estadística & datos numéricos , Antipsicóticos/administración & dosificación , Preparaciones de Acción Retardada/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina/estadística & datos numéricos , Esquizofrenia/epidemiología , Estados Unidos/epidemiología , Estados Unidos/etnología , Adulto JovenRESUMEN
OBJECTIVE: This study was conducted to examine whether medication continuity among Medicaid beneficiaries with schizophrenia and bipolar disorder was associated with medication utilization management practices (prior authorization, copayment amounts, and refill and pill quantity limits), managed care enrollment, and other state and beneficiary characteristics. METHODS: With 2007 Medicaid Analytic Extract claims data from 22 states, random-effects logistic regression modeled the odds of high medication continuity, defined as receiving medications for at least 80% of the days enrolled in Medicaid, among beneficiaries ages 18-64 with a diagnosis of schizophrenia (N=91,451) or bipolar disorder (N=33,234). RESULTS: Sixty-four percent of beneficiaries with schizophrenia and 54% of beneficiaries with bipolar disorder had high medication continuity. Medication continuity was worse among beneficiaries with schizophrenia in states that required prior authorization for antipsychotics, $2-$3 copayments for generic medications, or $1 copayments for branded medications (compared with no copayments). For beneficiaries with bipolar disorder, medication continuity was worse among those in states with more prior-authorization requirements for different classes of medications or $1 copayments for branded medications. Medication continuity was worse among beneficiaries who were African American, Hispanic, younger, or enrolled in a health maintenance organization health plan or who had a comorbid substance use disorder or cardiovascular disease. CONCLUSIONS: Prior-authorization requirements and copayments for medications may present barriers to refilling medications for Medicaid beneficiaries with schizophrenia or bipolar disorder. State Medicaid programs should consider the unintended consequences of medication utilization management practices for this population.