The Role of Clinical Setting and Management Approach in Metabolic Testing Among Youths and Adults Treated With Antipsychotics.
OBJECTIVE
This study compared metabolic screening among patients who received antipsychotic treatment at community mental health centers (CMHCs), with or without case management, and patients treated elsewhere.


METHODS
Rates of glucose and lipid testing among youths and adults in Missouri Medicaid (N=9,473) who received antipsychotic treatment at CMHCs, with and without case management, were evaluated. Multivariable logistic regressions determined which characteristics were independently associated with metabolic testing.


RESULTS
A total of 37.0% and 17.3% of youths and 68.7% and 34.9% of adults had glucose and lipid testing, respectively. Compared with treatment elsewhere, treatment at CMHCs, with or without case management, respectively, was associated with higher odds of glucose testing (youths, adjusted odds ratio [AOR]=1.68 and 1.89; adults, AOR=1.43 and 1.44) and lipid testing (youths, AOR=2.40 and 2.35; adults, AOR=1.97 and 1.48).


CONCLUSIONS
CMHCs had higher rates of metabolic testing, possibly reflecting Missouri's efforts to promote testing in these settings.
Dr. Nicol is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri (e-mail: nicolg@wustl.edu ). Ms. Campagna and Dr. Morrato are with the Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Denver. Dr. Garfield is with Mercy Virtual Care Center, St. Louis. Dr. Newcomer is with the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Dr. Parks is with MO HealthNet, Missouri Department of Social Services, Jefferson City, and with the Missouri Institute of Mental Health, University of Missouri-St. Louis.
Ginger E
GE
Nicol
Dr. Nicol is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri (e-mail: nicolg@wustl.edu ). Ms. Campagna and Dr. Morrato are with the Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Denver. Dr. Garfield is with Mercy Virtual Care Center, St. Louis. Dr. Newcomer is with the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Dr. Parks is with MO HealthNet, Missouri Department of Social Services, Jefferson City, and with the Missouri Institute of Mental Health, University of Missouri-St. Louis.
Elizabeth J
EJ
Campagna
Dr. Nicol is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri (e-mail: nicolg@wustl.edu ). Ms. Campagna and Dr. Morrato are with the Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Denver. Dr. Garfield is with Mercy Virtual Care Center, St. Louis. Dr. Newcomer is with the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Dr. Parks is with MO HealthNet, Missouri Department of Social Services, Jefferson City, and with the Missouri Institute of Mental Health, University of Missouri-St. Louis.
Lauren D
LD
Garfield
Dr. Nicol is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri (e-mail: nicolg@wustl.edu ). Ms. Campagna and Dr. Morrato are with the Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Denver. Dr. Garfield is with Mercy Virtual Care Center, St. Louis. Dr. Newcomer is with the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Dr. Parks is with MO HealthNet, Missouri Department of Social Services, Jefferson City, and with the Missouri Institute of Mental Health, University of Missouri-St. Louis.
John W
JW
Newcomer
Dr. Nicol is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri (e-mail: nicolg@wustl.edu ). Ms. Campagna and Dr. Morrato are with the Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Denver. Dr. Garfield is with Mercy Virtual Care Center, St. Louis. Dr. Newcomer is with the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Dr. Parks is with MO HealthNet, Missouri Department of Social Services, Jefferson City, and with the Missouri Institute of Mental Health, University of Missouri-St. Louis.
Joseph J
JJ
Parks
Dr. Nicol is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri (e-mail: nicolg@wustl.edu ). Ms. Campagna and Dr. Morrato are with the Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Denver. Dr. Garfield is with Mercy Virtual Care Center, St. Louis. Dr. Newcomer is with the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton. Dr. Parks is with MO HealthNet, Missouri Department of Social Services, Jefferson City, and with the Missouri Institute of Mental Health, University of Missouri-St. Louis.
Elaine H
EH
Morrato
D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001786:Blood Glucose / Q000032:analysis*; D019090:Case Management; D003155:Community Mental Health Centers; D019468:Disease Management; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008484:Medicaid; D001523:Mental Disorders / Q000188:drug therapy / Q000378:metabolism*; D008875:Middle Aged; D008923:Missouri; D015999:Multivariate Analysis; D016017:Odds Ratio; D014481:United States; D055815:Young Adult
D014150:Antipsychotic Agents; D001786:Blood Glucose; D008055:Lipids