Psychiatric Medication Changes Associated With Increased Rate of Medical Readmissions in Patients With Serious Mental Illness

Abstract

To identify the impact of postdischarge psychiatric medication changes on general medical readmissions among patients with serious mental illness (SMI; bipolar disorder, major depressive disorder, and schizophrenia), claims from a 5% national sample of Medicare fee-for-service (FFS) beneficiaries hospitalized between 2013 and 2016 were studied. A total of 165,490 Medicare FFS beneficiaries with SMI 18 years or older with at least 1 year of continuous Medicare enrollment were identified. Within 30 days of discharge from index admission, 47.4% experienced a psychiatric medication change—including 75,892 beneficiaries experiencing a deletion and 55,713 experiencing an addition. After adjusting for potential confounders, those with a medication change experienced an 10% increase in the odds of 30-day readmission (odds ratio, 1.10; SE, 0.019; p < 0.001). Comorbid drug use disorder was also associated with an increased odds of readmission after controlling for other covariates. These findings suggest important factors that clinicians should be aware of when discharging patients with SMI.

Risk factors associated with 30‐day unplanned hospital readmission for patients with mental illness

“…Germack et al . (2021) also identified a 10% increase in readmission if patients are of a non‐Hispanic Black race.…”

“…Compared with patients younger than 53 years, patients who were 54 years old had a lower readmission rate (Germack et al . 2021). On the contrary, when the reference group was >85 years, patients aged 18–64 years had a 10–28% more chance of being readmitted (Weinstein et al .…”

“…2016) or bipolar (Germack et al . 2021). Patients with a history of violence were also significantly associated with UHRs (OR = 1.30; 95% CI 1.09–1.55) (Hariman et al .…”

“…The categories are the circulatory system; digestive system; respiratory system; infectious and parasitic diseases; and endocrine system (Germack et al . 2021).…”

Rural-urban prescribing patterns by primary care and behavioral health providers in older adults with serious mental illness

“…Providing high quality care for older adults with behavioral health conditions is challenging for many reasons. Older adults often have multiple chronic conditions, and individuals with SMI have particularly high rates of comorbidities [ 6 , 7 ] and complex medication schedules [ 8 , 9 ]. Numerous studies have identified higher rates of cardiovascular disease, obesity, and metabolic syndrome in people with mental illness than in the general population.…”