Evidence-Based Practices for Medicaid Beneficiaries with Schizophrenia and Bipolar Disorder. 2. Medication Monitoring for Lithium and Anticonvulsants

04/09/2012

We found a two to three-fold difference between states with the highest and lowest rates of medication monitoring for lithium and evidence-based anticonvulsants (carbamazepine and valproate) (Figure 5). In states with the poorest rates of medication monitoring, between one-fifth to one-third of beneficiaries with bipolar disorder who received the medication were monitored (Table 6). However, the proportion of beneficiaries who received monitoring tended to cluster; depending on the state, between 65 percent and 80 percent of beneficiaries on lithium received lithium monitoring, 40 percent and 60 percent of those on carbamazepine received carbamazepine monitoring, and 45 percent and 65 percent of those on valproate received valproate monitoring during 2007.

TABLE 6. Proportion of Medication Users Receiving Recommended Blood Tests for Medication Level Monitoring or Health Screenings

  State  

  Percent of Anticonvulsant Users Receiving Medication Monitoring  

  Percent of Antipsychotic Users Receiving Health Screenings  

  Lithium  Users

  Valproate  Users

  Carbamazepine  Users

  Cholesterol  Screening

Glucose  Screening  

Median   69.2 58.9 50.0 43.6 12.8

SOURCE: MAX data, calendar year 2007.

NOTE: Data from Maryland is not displayed, as very low rates of medication monitoring and health screenings may be a result of missing laboratory encounter data for HMO enrollees. Rates are not displayed when fewer than ten beneficiaries used the medication in 2007.

AK 45.0 35.3 n.r. 33.5 8.6
AL 67.5 58.9 52.4 43.6 15.8
CA 64.6 52.6 50.4 52.4 13.3
CT 79.3 60.6 47.6 40.1 29.7
DC 35.1 30.8 30.8 44.7 5.6
GA 71.8 59.3 48.2 9.1 5.7
ID 75.5 52.6 41.9 47.2 9.0
IL 47.2 37.0 41.0 24.2 9.6
IN 69.5 66.1 52.6 47.3 18.5
IA 77.2 66.0 32.1 41.1 20.2
LA 78.0 64.0 66.0 47.0 12.8
MD n.r. n.r. n.r. n.r. n.r.
MS 69.2 59.2 50.0 39.2 11.8
MO 64.3 54.6 44.4 43.0 9.8
NC 74.6 64.8 61.7 52.4 11.1
ND 50.0 83.3 n.r. 60.0 22.4
NH 91.2 75.4 46.7 58.6 22.5
NV 47.5 49.5 43.5 42.9 8.9
OK 64.7 49.0 55.6 39.0 12.9
SD 69.2 47.4 n.r. 45.2 25.2
WV 73.1 63.4 57.9 49.8 13.0
WY 71.4 58.3 n.r. 33.5 4.8

Although we had few beneficiaries enrolled in managed care, we did observe that in two of the three states (California and Indiana) where beneficiaries were enrolled in an HMO, beneficiaries enrolled in managed care had lower rates of medication monitoring than those not enrolled. For example, among valproate users in California, 45 percent of those enrolled in an HMO received laboratory tests to monitor medication levels, compared to 55 percent of beneficiaries who were not enrolled in managed care for any part of the year. Similarly, in Indiana 50 percent of HMO enrollees using valproate received medication monitoring compared to 67 percent not enrolled in an HMO. Medication monitoring rates for other anticonvulsants displayed a similar pattern. In the third state (Maryland), potentially missing data among beneficiaries enrolled in managed care prevented us from reliably measuring medication monitoring.

View full report

Preview
Download

"ebpsbd.pdf" (pdf, 1005.36Kb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®