Quality of Preventive Medical Care for Patients With Mental Disorders

Druss, Benjamin G.; Rosenheck, Robert A.; Desai, Mayur M.; Perlin, Jonathan B.

doi:10.1097/00005650-200202000-00007

Cited by 332 publications

(193 citation statements)

References 32 publications

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“…Drug users have been reported to consume fewer ambulatory care services and more inpatient and emergency department services than nondrug users. [18][19][20] Our finding that hospital stays for soft tissue infections are much shorter (median 2 days) than previously reported (mean 12-13 days) 14,15 is consistent with a recent study in San Francisco (average stay 3.2 days). 7 While that study described an increase in health care utilization for all soft tissue infections, including those unrelated to injection drug use, the present study assessed health care utilization for soft tissue infections specifically related to injection drug use.…”

Section: Discussionsupporting

confidence: 88%

Type and Location of Injection Drug Use-Related Soft Tissue Infections Predict Hospitalization

Takahashi

Merrill

Boyko

et al. 2003

Journal of Urban Health: Bulletin of the New York Academy of Medicine

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Section: Discussionsupporting

confidence: 88%

Type and Location of Injection Drug Use-Related Soft Tissue Infections Predict Hospitalization

Takahashi

Merrill

Boyko

et al. 2003

Journal of Urban Health: Bulletin of the New York Academy of Medicine

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“…In contrast, prior studies did not control for the effects of race or comorbidity, or primarily focused on care for patients with SMI only 13 and did not compare quality of care to those with depression, one of the most common diagnoses seen in primary care settings.…”

Section: Discussionmentioning

confidence: 99%

“…We chose to adjust for these factors because they were found in prior studies to be the most strongly associated with receiving adequate quality of care in patients with mental disorders. 12,13,24 Patients diagnosed with both depression and SMI were classified as having SMI given that SMI is considered to be more debilitating. 19 The reference group was defined as having no SMI or depression diagnosis.…”

Section: Analysesmentioning

confidence: 99%

“…To date, the available evidence regarding appropriate care for CVD-related risk factors has focused primarily on lipid monitoring 10 or diabetes outcomes. 11,12 In general, the current evidence regarding quality of care for patients with and without mental disorders has been mixed, with some studies suggesting equitable care for procedures involving screening 13 but potential disparities when care involves more complex procedures or specialty services. 14 Moreover, these studies were conducted prior to the widespread use of atypical antipsychotic medications and did not control for patient factors, notably race/ethnicity or medical comorbidity.…”

Section: Introductionmentioning

confidence: 99%

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Quality of Care for Cardiovascular Disease-related Conditions in Patients with and without Mental Disorders

et al. 2008

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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.KEY WORDS: quality of care; cardiovascular disease; mental disorders.

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“…Previous work provides support for this hypothesis, although the data are not completely consistent. For example, in a study of patients receiving care at VA centers, Druss et al (2002) observed that patients with mental disorders, and particularly those with substance use diagnoses, were less likely to receive recommended preventive services (e.g., immunization and cancer screenings) than patients without psychiatric conditions. Similarly, Druss et al (2000) found that patients with psychiatric disorders were less likely than patients without these conditions to receive specialized cardiac procedures following hospitalization for acute myocardial infarction in nongovernmental acute care facilities.…”

Section: Discussionmentioning

confidence: 99%

Extent and Management of Cardiovascular Risk Factors in Patients With Type 2 Diabetes and Serious Mental Illness

Kreyenbuhl¹,

Dickerson²,

Medoff³

et al. 2006

Journal of Nervous &Amp; Mental Disease

103

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Cardiovascular disease is the leading cause of death in Type 2 diabetes, which commonly occurs in patients with serious mental illnesses (SMIs). We determined the extent to which patients with diabetes and SMI, relative to diabetes patients without SMI, met American Diabetes Association goals for cholesterol and blood pressure, met criteria for the metabolic syndrome, and were prescribed medications known to reduce cardiovascular events. We found that less than half of diabetes patients, both with and without SMI, met recommended goals for cholesterol levels; even fewer had adequate blood pressure control. In addition, a substantial proportion of all diabetes patients met metabolic syndrome criteria. However, diabetes patients with SMI were less likely to be prescribed cholesterol-lowering statin medications, angiotensin-converting enzyme inhibitors, and angiotensin receptor blocking agents than diabetes patients without SMI. Patients with both diabetes and SMI are treated less aggressively for high cardiovascular risk than diabetes patients without mental disorders. KeywordsType 2 diabetes; serious mental illness; cardiovascular risk; metabolic syndrome In 2002, Type 2 diabetes affected approximately 6.3% of the US population at an estimated cost of $132 billion (American Diabetes Association, 2003;Engelgau et al., 2004). Type 2 diabetes is associated with a twofold to fourfold increased risk for major cardiovascular events and is considered a coronary heart disease risk equivalent that confers a level of risk equal to that in patients with pre-existing cardiovascular disease (CVD; Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, 2001). Cardiovascular and cerebrovascular complications of Type 2 diabetes account for 60% to 75% of deaths from this disease (Stamler et al., 1993). Metabolic abnormalities characteristic of Type 2 diabetes including insulin resistance and dyslipidemias contribute in part to the increased CVD risk, with emerging evidence suggesting that persistent hyperglycemia may also play a role (Nathan et al., 2003;Selvin et al., 2004 NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript frequent co-occurrence of hypertension, overweight and obesity, smoking, and reduced physical activity in patients with diabetes confers an additive CVD risk that exceeds the sum of their risks individually (Wilson et al., 1998). There is also mounting evidence that the cluster of risk factors that comprise the metabolic syndrome increases the risk for cardiovascular mortality , and by definition, would be expected to occur disproportionately in people with Type 2 diabetes.Persons with serious mental illnesses such as schizophrenia have an increased risk for Type 2 diabetes (Dixon et al., 2000) and other co-occurring medical conditions. Life expectancy in people with schizophrenia is 20% shorter than that of the general population (Newman and Bland, 1991), with the excess mortality largely attributed to higher rates of CVD (Brown et al., 2000;Os...

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Quality of Preventive Medical Care for Patients With Mental Disorders

Cited by 332 publications

References 32 publications

Type and Location of Injection Drug Use-Related Soft Tissue Infections Predict Hospitalization

Type and Location of Injection Drug Use-Related Soft Tissue Infections Predict Hospitalization

Quality of Care for Cardiovascular Disease-related Conditions in Patients with and without Mental Disorders

Extent and Management of Cardiovascular Risk Factors in Patients With Type 2 Diabetes and Serious Mental Illness

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