Close to three-quarters of California Medicaid patients identified as having severe mental illness are not being adequately screened for diabetes despite a higher likelihood of chronic disease in that population, a new study found.
Among more than 50,000 Medi-Cal patients ages 18 and older diagnosed with severe mental illness who take antipsychotic medications, only 30% had received diabetes-specific screening during the period, according to a research letter published online Monday in the journal JAMA Internal Medicine.
The findings underscore the importance of improving primary care and care coordination for patients with severe behavioral health issues, the researchers said.
Patients with physical and behavioral healthcare needs have long been recognized as among the most complex and most expensive to treat. An estimated 50 million Medicaid beneficiaries have some form of mental illness, according to a 2012 report by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured (PDF). Of that number, 61% also had some kind of chronic physical condition.
A team of researchers led by Dr. Christina Mangurian, associate professor of clinical psychiatry at UCSF School of Medicine, looked at screening patterns of patients during two study periods. The first was for the calendar year 2009 and the second from Oct. 1, 2010, through Sept. 30, 2011.
Patients who had at least one outpatient visit with a primary-care physician during the study period were more likely to have received a diabetes-specific screening, defined as a blood glucose tests that required fasting.
Nearly 40% of study participants had undergone screening with a nonfasting blood glucose test, while 31% had no screening at all during the period, researchers found.
Adults with serious mental illness tend to have higher rates of chronic conditions such as cardiovascular disease and diabetes and die an average of 25 years earlier than those without such comorbidities, according to a 2006 report from the National Association of State Mental Health Program Directors.
“This observation supports the value of burgeoning efforts to integrate behavioral health and primary care,” the study concluded. “Growing evidence supports the value of screening for diabetes mellitus in higher-risk populations, such as those receiving treatment with antipsychotic medications, including first-generation and second-generation agents that commonly result in co-occurring obesity. Future studies should explore barriers to screening in this vulnerable population.”
The American Diabetes Association has recommended annual diabetes screening for patients taking antipsychotic drugs, which has been recognized as contributing to an elevated risk of Type 2 diabetes for patients with severe mental illness.
A growing number of healthcare providers in recent years have attempted to integrate behavioral health and primary-care services to better address the health needs of this group, who are among the most frequent users of emergency departments.
But many remain hindered in such efforts by traditional regulatory frameworks that make it difficult for primary-care and behavioral health clinicians to collaborate on a patient's care. Low payment rates coupled with rules such as Medicaid's policy prohibiting providers to be paid separately for medical care and behavioral healthcare delivered in the same patient visit remain barriers to greater integration of physical and behavioral healthcare services.
