Comorbid cardiometabolic health conditions are a significant burden to the health of patients with schizophrenia representing a major source of morbidity and mortality. Despite their burden, there is evidence to suggest that providers poorly manage comorbid problems in patients with schizophrenia. One oft-cited reason for this mismanagement is poor care coordination between psychiatric specialists treating the mental health needs of patients and primary care providers managing other symptoms. For patients taking medications to manage schizophrenia and comorbid health conditions, poor care coordination can result in inappropriate prescribing, duplication of medication therapy, medication non-adherence, and more aggressive health service utilization for high expenditure intensive resources such as inpatient hospitalizations and emergency room encounters. This study extends upon prior work performed by the research team to better understand continuity of medication management (COMM) in a Medicaid population across multiple care settings and the role that a severe mental health condition (schizophrenia) has on COMM.
The first aim of this study is to examine the number and types of prescribers providing medications for Medicaid patients with one or more cardiometabolic conditions and the influence of schizophrenia on this relationship.
This aim will identify the extent of the number of providers and types of providers involved in patient care to target care coordination opportunities.
The second aim will compare medication adherence and health service utilization in patients with schizophrenia and one or more cardiometabolic health conditions receiving comanagement by a single psychiatrist and single primary care provider to patients using multiple psychiatric providers and/or multiple primary care providers. The results of this aim will examine the influence of comanagement between psychiatrists and PCPs on health outcomes in comparison to poor comanagement by multiple providers potentially duplicating treatment. The final study aim will examine the effect o the medical home at improving health outcomes among patients that are comanaged in aim 2. Patients will be included in the study if they have 2 or more of the following chronic health conditions: hypertension, hyperlipidemia, diabetes, and/or schizophrenia. Specific comparisons will be made between patients with a chronic cardiometabolic health condition with and without schizophrenia. The study uses Medicaid Analytical eXtract (MAX) claims data for 4 states with well validated prescriber information in prescription claims (Colorado, Kentucky, North Carolina, and Vermont) to address these questions. Medication adherence will be assessed using the Medication Possession Ratio for each of the medication classes used and health service utilization comparisons will be limited to high intensive services (inpatient admissions and emergency department visits). This study will improve our understanding of medication care coordination, the role of mental health in care coordination, and the benefits of the medical home model at improving care for patients with multiple chronic conditions.

Public Health Relevance

Patients with multiple chronic conditions face barriers to appropriate coordination of care placing them at greater risk for adverse health outcomes. The proposed study seeks to examine patterns of prescribing in patients with schizophrenia and comorbid health conditions to better understand the influence of continuous medication prescribing, appropriate comanagement by providers, and the influence of the medical home model on medication adherence and health service utilization. The results of this study will influence the adoption of comanagement models and medical home practices in Medicaid patients with multiple chronic conditions.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Research Project (R01)
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Special Emphasis Panel (ZHS1-HSR-X (01))
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Ricciardi, Richard
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University of North Carolina Chapel Hill
Schools of Pharmacy
Chapel Hill
United States
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