Serious mental illnesses associated with receipt of surgery in retrospective analysis of patients in the Veterans Health Administration

Copeland, Laurel A.; Zeber, John E.; Sako, Edward Y.; Mortensen, Eric M.; Pugh, Mary Jo; Wang, Chen Pin; Restrepo, Marcos I.; Flynn, J T; MacCarthy, Andrea A.; Lawrence, Valerie A.

doi:10.1186/s12893-015-0064-7

Cited by 31 publications

(55 citation statements)

References 40 publications

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“…The Scott & White Memorial Hospital Institutional Review Board exempted the study from oversight at Baylor Scott & White. Data were extracted from the STOPP data repository, a collection of administrative extracts from the VA’s all-electronic medical records system (EMR) on all patients treated during fiscal years 2006–2009 (FY2006-FY2009; Oct 2005-Sep 2009) [ 8 ] and from the VA’s Corporate Data Warehouse. Variables included dates and types of care, diagnoses, procedures, prescription medications, lab test results, outpatient care, and admission and inpatient stay details on 7 million veterans of US military service using the Veterans Health Administration for care.…”

Section: Methodsmentioning

confidence: 99%

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Association between triglyceride levels and cardiovascular disease in patients with acute pancreatitis

et al. 2018

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Conventional wisdom supports prescribing "fibrates before statins", that is, prioritizing treatment of hypertriglyceridemia (hTG) to prevent pancreatitis ahead of low-density lipoprotein cholesterol to prevent coronary heart disease. The relationship between hTG and acute pancreatitis, however, may not support this approach to clinical management. This study analyzed administrative data from the Veterans Health Administration for evidence of (1) temporal association between assessed triglycerides level and days to acute pancreatitis admission; (2) association between hTG and outcomes in the year after hospitalization for acute pancreatitis; (3) relative rates of prescription of fibrates vs statins in patients with acute pancreatitis; (4) association of prescription of fibrates alone versus fibrates with statins or statins alone with rates of adverse outcomes after hospitalization for acute pancreatitis. Only modest association was found between above-normal or extremely high triglycerides and time until acute pancreatitis. CHD/MI/stroke occurred in 23% in the year following AP, supporting cardiovascular risk management. Fibrates were prescribed less often than statins, defying conventional wisdom, but the high rates of cardiovascular events in the year following AP support a clinical focus on reducing cardiovascular risk factors.

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Section: Methodsmentioning

confidence: 99%

“…Additional conditions were assessed to understand variability in risk. Previous research has noted differences in post-hospitalization health outcomes for veterans with mental and behavioral disorders [ 8 ]. Alcohol disorders were indicated by ICD-9 diagnoses of 291, 303, or 305.0.…”

Section: Methodsmentioning

confidence: 99%

Association between triglyceride levels and cardiovascular disease in patients with acute pancreatitis

et al. 2018

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“…For example a patient with schizophrenia and MDD would be classified in the schizophrenia group and a patient with only MDD would be classified in the MDD group. This is an approach used in prior studies that have similarly employed a hierarchy of non-overlapping categories [21,22]. Eligible individuals had to have continuous health plan membership throughout 2015 and 2016 (but could have a gap in enrollment records of ≤30 days, as administrative gaps can occur as a result of delays in membership data processing and thus are not indicative of membership interruptions/disenrollment).…”

Section: Study Populationmentioning

confidence: 99%

Chronic pain diagnoses and opioid dispensings among insured individuals with serious mental illness

et al. 2020

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Background: Individuals with major depressive disorder (MDD) and bipolar disorder (BD) have particularly high rates of chronic non-cancer pain (CNCP) and are also more likely to receive prescription opioids for their pain. However, there have been no known studies published to date that have examined opioid treatment patterns among individuals with schizophrenia. Methods: Using electronic medical record data across 13 Mental Health Research Network sites, individuals with diagnoses of MDD (N = 65,750), BD (N = 38,117) or schizophrenia or schizoaffective disorder (N = 12,916) were identified and matched on age, sex and Medicare status to controls with no documented mental illness. CNCP diagnoses and prescription opioid medication dispensings were extracted for the matched samples. Multivariate analyses were conducted to evaluate (1) the odds of receiving a pain-related diagnosis and (2) the odds of receiving opioids, by separate mental illness diagnosis category compared with matched controls, controlling for age, sex, Medicare status, race/ethnicity, income, medical comorbidities, healthcare utilization and chronic pain diagnoses. Results: Multivariable models indicated that having a MDD (OR = 1.90; 95% CI = 1.85-1.95) or BD (OR = 1.71; 95% CI = 1.66-1.77) diagnosis was associated with increased odds of a CNCP diagnosis after controlling for age, sex, race, income, medical comorbidities and healthcare utilization. By contrast, having a schizophrenia diagnosis was associated with decreased odds of receiving a chronic pain diagnosis (OR = 0.86; 95% CI = 0.82-0.90). Having a MDD (OR = 2.59; 95% CI = 2.44-2.75) or BD (OR = 2.12; 95% CI = 1.97-2.28) diagnosis was associated with increased odds of receiving chronic opioid medications, even after controlling for age, sex, race, income, medical comorbidities, healthcare utilization and chronic pain diagnosis; having a schizophrenia diagnosis was not associated with receiving chronic opioid medications. Conclusions: Individuals with serious mental illness, who are most at risk for developing opioid-related problems, continue to be prescribed opioids more often than their peers without mental illness. Mental health clinicians may be particularly well-suited to lead pain assessment and management efforts for these patients. Future research is needed to evaluate the effectiveness of involving mental health clinicians in these efforts.

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“…We used inpatient and outpatient data on encounters, lab tests, procedures, and pharmacy fills as contained in the STOPP Research Data Repository. [ 22 ] Demographics included age, marital status, and gender. Comorbidity was assessed by the Selim Chronic Disease score counting 30 physical conditions and 6 mental illnesses.…”

Section: Methodsmentioning

confidence: 99%

Preventative care for patients with inflammatory bowel disease in the Veterans Health Administration

et al. 2016

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Patients with inflammatory bowel disease (IBD) have underlying immune dysregulation. Immunosuppressive medications put them at risk of infection. This study assessed rates of recommended vaccinations and preventative screening in patients with IBD.Nationwide data on patients diagnosed with IBD in the Veterans Health Administration (VHA) October 2004 to September 2014 were extracted. Variation in vaccination, screenings, and risk of death by demographic factors (age group, gender) were estimated in bivariate and multivariable analyses.During the 10-year study period, 62,002 patients were treated for IBD. Nonmelanoma skin cancer was found in 2.6%, and these patients more commonly accessed dermatology clinic (22.5% vs 15.2%; chi-square = 66.6; df = 1; P < 0.0001). In total, 15% received DEXA scans, especially women (34.7% vs 13.2% men; chi-square = 1415.5; df = 1; P < 0.0001). Eye manifestations were noted in 38.3% yet only 31% were referred to ophthalmology. Abnormal Pap smears were found for 15% of women <65 (compared to 5% among normal patient populations); 34% had no record of Pap smear in VHA data. Vaccination rates were modest: pneumococcal 39%; TDAP 23%; hepatitis B 3%; varicella and PPD <0.5%. In an adjusted logistic regression model, 5-year mortality was lower among those using primary care prior to IBD diagnosis (odds ratio [OR] = 0.61; 95% CI 0.55–0.68).Despite the current IBD guidelines, vaccination and preventative screening rates were unacceptably low among patients diagnosed with IBD. Interventions such as education and increased awareness may be needed to improve these rates.

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Serious mental illnesses associated with receipt of surgery in retrospective analysis of patients in the Veterans Health Administration

Cited by 31 publications

References 40 publications

Association between triglyceride levels and cardiovascular disease in patients with acute pancreatitis

Association between triglyceride levels and cardiovascular disease in patients with acute pancreatitis

Chronic pain diagnoses and opioid dispensings among insured individuals with serious mental illness

Preventative care for patients with inflammatory bowel disease in the Veterans Health Administration

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