Assessment of monitoring for glucose and lipid dysregulation in adult Medi-Cal patients newly started on antipsychotics.
BACKGROUND
Because patients receiving antipsychotics are at increased risk for coronary heart disease, standards of care for such patients now include periodic glucose and lipid testing. The objective of this study was to examine rates of glucose and lipid monitoring among adult Medicaid patients initiated on antipsychotic therapy.


METHODS
California Medicaid (Medi-Cal) claims of 6601 patients identified as "new" antipsychotic users between July 1, 2004 and June 30, 2005 were analyzed. Rates of glucose and lipid testing were compared for 6 months prior to and post-initiation of antipsychotic therapy. Odds ratios (ORs) for testing associated with first-generation antipsychotic (FGA) and second-generation antipsychotic (SGA) use were determined while controlling for patient level factors.


RESULTS
In a multivariate analysis, SGA patients were more likely than FGA patients to undergo glucose testing (OR, 1.38; 95% confidence interval [CI], 1.13 to 1.70; P < .01) and lipid testing (OR, 1.43; 95% CI, 1.14 to 1.81; P < .01), respectively. SGA patients were also more likely than FGA patients to receive both glucose and lipid testing in the 6 months following initiation of antipsychotic treatment (OR, 1.40; 95% CI, 1.11 to 1.79, P < .01).


CONCLUSIONS
Although increases in glucose and lipid testing rates were observed among Medi-Cal patients after initiation of antipsychotic therapy, recommended monitoring does not appear to occur universally in this population. Interventions to increase monitoring of these patients are warranted.
Barnett
Mitchell
M
Pharmacy Practice Department, College of Pharmacy, Touro-University California, 1310 Johnson Lane, Mare Island, Vallejo, CA 94592, USA.
VonMuenster
Shannon
S
Wehring
Heidi
H
Popish
Sarah
S
McDonald
Karna
K
Walker
Victor M
VM
Perry
Paul
P
D000328:Adult; D014150:Antipsychotic Agents / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D002140:California; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D050171:Dyslipidemias / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood*; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011618:Psychotic Disorders / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology; D012680:Sensitivity and Specificity; D014481:United States; D055815:Young Adult
D014150:Antipsychotic Agents; D015415:Biomarkers; D001786:Blood Glucose; D008055:Lipids