Patterns of primary care and mortality among patients with schizophrenia or diabetes: a cluster analysis approach to the retrospective study of healthcare utilization

Copeland, Laurel A.; Zeber, John E.; Wang, Chen Pin; Parchman, Michael L.; Lawrence, Valerie A.; Valenstein, Marcia; Miller, Alexander L.

doi:10.1186/1472-6963-9-127

Cited by 81 publications

(64 citation statements)

References 26 publications

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“…We specifically identified any diagnosis of mood disorders, psychotic disorders, substance including alcohol use disorders, post-traumatic stress disorder (PTSD), other anxiety disorders, traumatic brain injury (TBI), and pain diagnoses (ICD-9-CM codes available from authors on request). The Selim comorbidity index 18,19 was used to measure overall medical morbidity; it counts across 30 medical conditions and six mental conditions from ICD-9-CM diagnoses made in the prior year. We used a systematic, iterative process to develop a medical record data collection tool to record documentation of previously identified suicide risk factor variables in the 6 months prior to the index date; we have used similar approaches in prior studies.…”

Section: Methodsmentioning

confidence: 99%

Correlates of Suicide Among Veterans Treated in Primary Care: Case–Control Study of a Nationally Representative Sample

et al. 2014

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BACKGROUND: Veterans receiving Veterans Affairs (VA) healthcare have increased suicide risk compared to the general population. Many patients see primary care clinicians prior to suicide. Yet little is known about the correlates of suicide among patients who receive primary care treatment prior to death. OBJECTIVE: Our aim was to describe characteristics of veterans who received VA primary care in the 6 months prior to suicide; and to compare these to characteristics of control patients who also received VA primary care. DESIGN: This was a retrospective case-control study. SUBJECTS: The investigators partnered with VA operations leaders to obtain death certificate data from 11 states for veterans who died by suicide in 2009. Cases were matched 1:2 to controls based on age, sex, and clinician. MAIN MEASURES: Demographic, diagnosis, and utilization data were obtained from VA's Corporate Data Warehouse. Additional clinical and psychosocial context data were collected using manual medical record review. Multivariate conditional logistic regression was used to examine associations between potential predictor variables and suicide. KEY RESULTS: Two hundred and sixty-nine veteran cases were matched to 538 controls. Average subject age was 63 years; 97 % were male. Rates of mental health conditions, functional decline, sleep disturbance, suicidal ideation, and psychosocial stressors were all significantly greater in cases compared to controls. In the final model describing men in the sample, non-white race (OR=0.51; 95 % CI=0.27-0.98) and VA service-connected disability (OR=0.54; 95 % CI=0.36-0.80) were associated with decreased odds of suicide, while anxiety disorder (OR=3.52; 95 % CI=1.79-6.92), functional decline (OR=2.52; 95 % CI=1.55-4.10), depression (OR =1.82; 95 % CI=1.07-3.10), and endorsement of suicidal ideation (OR=2.27; 95 % CI=1.07-4.83) were associated with greater odds of suicide. CONCLUSIONS: Assessment for anxiety disorders and functional decline in addition to suicidal ideation and depression may be especially important for determining suicide risk in this population. Continued development of interventions that support identifying and addressing these conditions in primary care is indicated.KEY WORDS: mental health; veterans; primary care; health services research.

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Section: Methodsmentioning

confidence: 99%

Correlates of Suicide Among Veterans Treated in Primary Care: Case–Control Study of a Nationally Representative Sample

et al. 2014

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“…Although community mental health clinics (CMHCs) provide services to the vast majority of people with SMI-more than 3.5 million adults served each year-close to 50 % of these clinics do not have a standard primary care referral process. 4,106 In addition, because of poor funding in certain regions, Community Health Clinics (CHC) serve this population without support of mental health providers. One way to ensure improved cardiovascular disease risk screening and care is to invest in integration of behavioral and primary care programs.…”

Section: Clinical and Policy Implicationsmentioning

confidence: 99%

Diabetes and Cardiovascular Care Among People with Severe Mental Illness: A Literature Review

et al. 2016

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Close to 19 million US adults have severe mental illnesses (SMI), and they die, on average, 25 years earlier than the general population, most often from cardiovascular disease (CVD). Many of the antipsychotic medications used to treat SMI contribute to CVD risk by increasing risk for obesity, type 2 diabetes, dyslipidemia, and hypertension. Based on compelling evidence, the American Diabetes Association and the American Psychiatric Association developed guidelines for metabolic screening and monitoring during use of these medications. In this manuscript, we have reviewed the evidence on diabetes and other CVD risk screening, prevalence, and management among populations with SMI. We also review differences in screening among subpopulations with SMI (e.g., racial/ethnic minorities, women, and children). We found that despite national guidelines for screening for diabetes and other cardiovascular risk factors, up to 70 % of people taking antipsychotics remain unscreened and untreated. Based on estimates that 20 % of the 19 million US adults with SMI have diabetes and 70 % of them are not screened; it is likely that over 2 million Americans with SMI have unidentified diabetes. Given that undiagnosed diabetes costs over $4,000 per person, this failure to identify diabetes among people with SMI represents a missed opportunity to prevent morbidity and translates to over $8 billion in annual preventable costs to our healthcare system. Given the high burden of disease and significant evidence of suboptimal medical care received by people with SMI, we propose several clinical and policy recommendations to improve diabetes and other CVD risk screening and care for this highly vulnerable population. These recommendations include reducing antipsychotic medication dose or switching antipsychotic medications, enhancing smoking cessation efforts, sharing electronic health records between physical and mental health care systems, and promoting integration of care.KEY WORDS: mental illness; diabetes; integration of care.

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“…11,12 Continuity of primary care is associated with treatment retention and survival benefit. 13 Psychoses are more common among black African or Caribbean groups, 14,15 and the accumulation of cardiovascular risk factors in these groups is associated with additional comorbidities and mortality. Few studies have considered the joint contributions of ethnicity and deprivation to measures of care provision.…”

Section: Introductionmentioning

confidence: 99%

Ethnic differences in primary care management of diabetes and cardiovascular disease in people with serious mental illness

et al. 2012

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BackgroundPatients with serious mental illness (SMI) have high rates of cardiovascular disease (CVD). In contrast to widespread perception, their access to effective chronic disease management is as high as for the general population. However, previous studies have not included analysis by ethnicity. AimTo identify differences in CVD and diabetes management, by ethnicity, among people with SMI. Design and settingThree inner east London primary care trusts with an ethnically diverse and socially deprived population. Data were obtained from 147 of 151 general practices. MethodCoded demographic and clinical data were obtained from GP electronic health records using EMIS Web. The sample used was the GP registered population on diabetes or CVD registers (52 620); of these, 1223 also had SMI. ResultsThe population prevalence of CVD and diabetes is 7.2%; this rises to 18% among those with SMI. People with SMI and CVD or diabetes were found to be as likely to achieve clinical targets as those without SMI. Blood pressure control was significantly better in people with SMI; however, they were more likely to smoke and have a body mass index above 30 kg/m 2 . Ethnic differences in care were identified, with south Asian individuals achieving better cholesterol control and black African or Caribbean groups achieving poorer blood pressure control. ConclusionRisk factor management for those with SMI shows better control of blood pressure and glycosylated haemoglobin than the general population. However, smoking and obesity rates remain high and should be the target of public health programmes. Ethnic differences in management mirror those in the general population. Ethnic monitoring for vulnerable groups provides evidence to support schemes to reduce health inequalities.Keywords cardiovascular diseases; diabetes mellitus; ethnicity; health; inequalities; mental disorders; primary care.

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Patterns of primary care and mortality among patients with schizophrenia or diabetes: a cluster analysis approach to the retrospective study of healthcare utilization

Cited by 81 publications

References 26 publications

Correlates of Suicide Among Veterans Treated in Primary Care: Case–Control Study of a Nationally Representative Sample

Correlates of Suicide Among Veterans Treated in Primary Care: Case–Control Study of a Nationally Representative Sample

Diabetes and Cardiovascular Care Among People with Severe Mental Illness: A Literature Review

Ethnic differences in primary care management of diabetes and cardiovascular disease in people with serious mental illness

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