Racial differences in the treatment of veterans with bipolar disorder.
OBJECTIVE
The authors examined whether African Americans, compared with whites, received guideline-concordant care for bipolar I disorder.


METHODS
A retrospective analysis was conducted of data for patients who received a diagnosis of bipolar I disorder in fiscal year 2001 and received care in facilities in the Department of Veterans Affairs (VA) mid-Atlantic region. Indicators of guideline-concordant care were based on prescription data and data on utilization of inpatient and outpatient services from VA databases.


RESULTS
A total of 2,316 patients with a diagnosis of bipolar I disorder were identified. Their mean age was 52 years; 9.4 percent (N=218) were women, and 13.1 percent (N=303) were African American. Overall, mood stabilizers were prescribed for 74.6 percent (N=1,728) of the patients; 67.1 percent (N=1,554) had an outpatient mental health visit within 90 days after the index diagnosis, and 54.3 percent (N=1,258) had an outpatient visit within 30 days after discharge from a psychiatric hospitalization. Multivariate logistic regression analyses with adjustment for sociodemographic and facility factors revealed that African Americans were less likely than whites to have an outpatient follow-up visit within 90 days after the index diagnosis. Race was not associated with receipt of mood stabilizers or use of outpatient services after a hospital discharge.


CONCLUSIONS
Although a majority of patients received guideline-concordant care for bipolar disorder, potential gaps in continuity of outpatient care may exist for African-American patients.
Kilbourne
Amy M
AM
Department of Veterans Affairs Pittsburgh Healthcare System, and the Department of Psychiatry, University of Pittsburgh, PA 15240, USA.
Bauer
Mark S
MS
Han
Xiaoyan
X
Haas
Gretchen L
GL
Elder
Patrick
P
Good
Chester B
CB
Shad
Mujeeb
M
Conigliaro
Joseph
J
Pincus
Harold
H
D001741:Black or African American / Q000706:statistics & numerical data*; D001714:Bipolar Disorder / Q000628:therapy*; D003266:Continuity of Patient Care; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012189:Retrospective Studies; D014728:Veterans; D044465:White People / Q000706:statistics & numerical data*