Changes Over Time and Disparities in Schizophrenia Treatment Quality

Busch, Alisa B.; Lehman, Anthony F.; Goldman, Howard H.; Frank, Richard G.

doi:10.1097/mlr.0b013e31818475b7

Cited by 45 publications

(47 citation statements)

References 28 publications

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“…Asians not only were much less likely to receive a diagnosis of depression but when diagnosed, were 55% less likely than non-Hispanic whites to receive a medication to treat this condition. In contrast with findings from a decade ago, we found no significant differences in use of psychotropic drugs across racial/ethnic groups with schizophrenia and other psychosis 11, 32, 33 . One reason for this difference may be that the previous studies focused on patients from the Veterans Health Administration 7, 11, 34 or Medicaid 19, 35, 36 which tend to serve the most disadvantaged patients.…”

Section: Discussioncontrasting

confidence: 99%

Racial-Ethnic Differences in Psychiatric Diagnoses and Treatment Across 11 Health Care Systems in the Mental Health Research Network

Coleman¹,

Stewart²,

Waitzfelder³

et al. 2016

107

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Objective The objective of this study is to characterize racial/ethnic variation in mental health diagnoses and treatments in large not-for-profit healthcare systems. Method Participating systems were 11 private, not-for-profit healthcare organizations constituting the Mental Health Research Network (MHRN) and had a combined 7,523,956 patients aged 18 years or older, who received care during 2011. Rates of diagnoses, psychotropic medications, and formal psychotherapy sessions received were obtained from insurance claims and electronic medical record databases across all healthcare settings. Results Of the 7,523,956 patients in the study, 1,169,993 (15.6%) received a mental health diagnosis in 2011. This varied significantly by race/ethnicity with Native American/Alaskan Native patients having the highest rates of any diagnosis (20.6%) and Asians having the lowest rates (7.5%). Among patients with a mental health diagnosis, 73% (n = 850,585) received a psychotropic medication. Non-Hispanic white patients were significantly more likely (77.8%) than other racial/ethnic groups (range 61.5% to 74.0%) to receive medication. In contrast, only 34% of patients with a mental health diagnosis (n = 548,837) received formal psychotherapy. Racial/ethnic differences were most pronounced for depression and schizophrenia where non-Hispanic blacks were 20% more likely to receive formal psychotherapy for their depression and 2.64 times more likely to receive formal psychotherapy for their schizophrenia when compared to whites. Conclusions There were significant racial/ethnic differences in diagnosis and treatment of mental health conditions across 11 U.S. healthcare systems. Further study is needed to understand underlying causes of these observed differences and whether processes and outcomes of care are equitable across these diverse patient populations.

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Section: Discussioncontrasting

confidence: 99%

Racial-Ethnic Differences in Psychiatric Diagnoses and Treatment Across 11 Health Care Systems in the Mental Health Research Network

Coleman¹,

Stewart²,

Waitzfelder³

et al. 2016

107

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“…(4) Given the low rates of outpatient treatment for psychiatric and medical conditions in this vulnerable and costly population,(7, 8, 10, 11) it is likely that some patients benefitted from the increased use of outpatient care. Additional research is needed to assess the impact of this coverage change on beneficiaries' health, functioning, and satisfaction, as well as the efficiency of the resulting care.…”

Section: Resultsmentioning

confidence: 99%

The Effects of the Transition From Medicaid to Medicare on Health Care Use for Adults With Mental Illness

et al. 2016

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Background The transition from Medicaid-only to dual Medicare/Medicaid coverage has the potential to reduce financial barriers to health care for patients with serious mental illness (SMI) through increased coverage or expanded access to clinicians as their reimbursement increases. Aims To estimate the effect of dual coverage after Medicaid enrollment during the required waiting period among adults with SMI on health care use, overall and related to mental health and substance use disorders (MHSUD). Methods Data include enrollment and claims from Medicaid and Medicare in Missouri (MO) and South Carolina (SC), from January 2004 – December 2007. We used an interrupted time series design to estimate the effect of dual coverage on average use of outpatient, emergency (ED), and inpatient care/month. Results After 12-months of dual coverage, the probability of outpatient care use increased in both states from 4 – 9%. In MO the mean probability and frequency of ED visits, total and MHSUD-related, increased by 21–32%; the probability of all-cause and MHSUD-related inpatient admissions increased by 10% and 19% respectively. In SC, the mean probability of any inpatient admission increased by 27% and of any MHSUD-related inpatient admission by 42%. Discussion The increase in use of outpatient care is consistent with the expected increase in coverage of, and payment for, outpatient services under dual coverage relative to Medicaid-only. Sustained increases in ED and inpatient admissions raise questions regarding the complexity of obtaining care under 2 programs, pent-up demand among beneficiaries pre-transition, and the complementarity of outpatient and inpatient service use.

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“…Potential correlates for the analyses of prescribing patterns were chosen based on the following. Sex (10), racial background (11–13) and ethnicity (14) influence antipsychotic response or prescription patterns with multi-episode patients. Cigarette smoking decreases blood levels of some psychotropics (15).…”

Section: Methodsmentioning

confidence: 99%

Prescription Practices in the Treatment of First-Episode Schizophrenia Spectrum Disorders: Data From the National RAISE-ETP Study

Robinson¹,

Schooler²,

John³

et al. 2015

AJP

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Objective Treatment guidelines suggest distinctive medication strategies for first episode and multi-episode patients with schizophrenia. How much community clinicians adjust their usual treatment regimens for first episode patients is unknown. We examined prescription patterns and factors associated with prescription choice within a national cohort of early phase patients. Method Study entry prescription data (before any influence on treatment by study procedures) were obtained from 404 participants in the RAISE-ETP study, a US nationwide effectiveness study conducted at 34 community treatment centers in 21 states for patients with first episode schizophrenia-spectrum disorders. Subjects had been treated with antipsychotics for 6 months or less at study entry. Results We identified 159 subjects (39.4% of the sample) who might benefit from changes in their psychotropic prescriptions. Of these 159 subjects, 8.8% were prescribed recommended antipsychotics at higher than recommended doses, 32.1% were prescribed olanzapine (often at high doses), 23.3% more than one antipsychotic, 36.5% an antipsychotic but also an antidepressant without a clear indication, 10.1% psychotropic medications without an antipsychotic and 1.2% stimulants. Multivariate analyses found evidence for sex, age and insurance status effects on medication prescription. Racial and ethnic effects consistent with effects found in prior multi-episode studies were found in univariate analyses. There were some regional variation in prescription practices; when present, regional patterns varied across prescribing practices. Diagnosis had limited, and inconsistent, effects. Conclusions Besides prescriber education, policy makers may need to consider not only patient factors but also service delivery factors in efforts to improve first episode prescription practices. Clinical Trials registration NCT01321177: An Integrated Program for the Treatment of First Episode of Psychosis (RAISE ETP), http://www.clinicaltrials.gov/ct2/show/NCT01321177

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Changes Over Time and Disparities in Schizophrenia Treatment Quality

Cited by 45 publications

References 28 publications

Racial-Ethnic Differences in Psychiatric Diagnoses and Treatment Across 11 Health Care Systems in the Mental Health Research Network

Racial-Ethnic Differences in Psychiatric Diagnoses and Treatment Across 11 Health Care Systems in the Mental Health Research Network

The Effects of the Transition From Medicaid to Medicare on Health Care Use for Adults With Mental Illness

Prescription Practices in the Treatment of First-Episode Schizophrenia Spectrum Disorders: Data From the National RAISE-ETP Study

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