Evidence-Based Practices for Medicaid Beneficiaries with Schizophrenia and Bipolar Disorder. A. Variance in Medication Use, Continuity, and Monitoring by Beneficiary Characteristics

04/09/2012

Medication continuity was poorer among beneficiaries who were younger, African American, or had a comorbid substance abuse disorder (Table 2). In multivariate models, these differences were statistically significant after controlling for a range of other Medicaid program and mental health system characteristics, described in the next chapter. In bivariate analyses, medication continuity did not substantially differ by beneficiary gender or residence in a rural area and was only slightly lower for beneficiaries living in a mental health provider shortage area. Any medication use, measured as having at least one claim for an evidence-based medication, was not associated with beneficiary characteristics.

Among beneficiaries who received antipsychotics, those who were African American were the least likely to receive screening for cardiovascular disease and diabetes (Figure 2). African Americans were also less likely to receive monitoring of lithium and valproate. Hispanic beneficiaries had lower rates of medication monitoring for lithium and valproate, but slightly higher rates of cardiovascular and glucose screening for antipsychotic use.

TABLE 2. Proportion of Medicaid Beneficiaries with Schizophrenia or Bipolar Disorder with High Medication Continuity

Beneficiary Characteristics

  Proportion with High  Medication Continuity

All beneficiaries with schizophrenia or bipolar disorder   61.4
Race or ethnicity
   African American 51.0
   Caucasian 67.0
   Hispanic 62.1
   Other/Unknown 67.5
Age
   18-24 52.8
   25-30 56.4
   31-40 57.7
   41-50 60.8
   51-60 67.8
   61-64 74.0
Comorbid conditions
   Substance abuse 46.0
   Cardiovascular disease 61.1
   Diabetes 69.3

SOURCE: MAX data, calendar year 2007.

NOTE: We measured high medication continuity as the beneficiary receiving an evidence-based medication for at least 80 percent of days enrolled in Medicaid in the calendar year following the first receipt of that medication.

Older beneficiaries were more likely to receive screening for cardiovascular disease but not diabetes. Gender was not systemically associated with screening for cardiovascular disease or diabetes. Age and gender were not associated with monitoring of lithium or anticonvulsants. Living in a physician or mental health provider shortage or rural area was not clearly associated with medication monitoring or health screening in bivariate analyses.

As illustrated in Table 3, among beneficiaries with schizophrenia who received antipsychotics, a larger proportion of those who were African American or younger received depot antipsychotics, compared with their older or Caucasian counterparts. The receipt of depot antipsychotics did not differ substantially by beneficiary gender, rural residence, or residence in a mental health provider or physician shortage area. The small sample size did not allow for an examination of whether the receipt of depot antipsychotics was associated with specific beneficiary characteristics.

FIGURE 2. Proportion of Medication Users Who Received Recommended Medication Monitoring or Health Screenings, by Race and Ethnicity

Figure 2 is a bar chart with 5 groups of three bars each. The five groups along the horizontal access are the users of different medications who received the recommended blood tests for medication level monitoring or health screenings. Within each group, the three bars represent the proportion of Caucasian, Hispanic, and African American beneficiaries who received the recommended test. The first set of bars shows that among beneficiaries taking lithium, 68 percent of Caucasians, 64 percent of Hispanics, and 60 percent of African Americans received a blood test to monitor medication levels. The second set of bars shows that among beneficiaries taking valproate, 58 percent of Caucasians, 46 percent of Hispanics, and 45 percent of African Americans received a blood test to monitor medication levels. The third set of bars shows that among beneficiaries taking carbamazepine, 50 percent of Caucasians and Hispanics and 48 percent of African Americans received a blood test to monitor medication levels. The fourth set of bars shows that among beneficiaries taking an antipsychotic, 45 percent of Caucasians, 50 percent of Hispanics, and 36 percent of African Americans received a cholesterol screening for heart disease. The fifth set of bars shows that among beneficiaries taking an antipsychotic, 13 percent of Caucasians, 15 percent of Hispanics, and 12 percent of African Americans received a glucose screening for diabetes.

SOURCE: MAX data, calendar year 2007.


TABLE 3. Proportion of Medicaid Beneficiaries with Schizophrenia who Received Depot Antipsychotics

Beneficiary Characteristic

  Proportion with Schizophrenia Who  Received Depot Antipsychotics

All beneficiaries with schizophrenia who received antipsychotics   10.7
Race or ethnicity
   African American 12.9
   Caucasian 9.6
   Hispanic 8.7
   Other/Unknown 8.9
Age
   18-24 13.2
   25-30 13.0
   31-40 10.3
   41-50 10.5
   51-60 9.8
   61-64 9.3

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