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.
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
SOURCE: MAX data, calendar year 2007.