title: Continuity of medication management in Medicaid patients with chronic comorbid conditions: An examination by mental health status.
abstract: Patients with serious mental illness (SMI) often have comorbid cardiometabolic conditions (CMCs) that may increase the number of prescribers involved in treatment. This study examined whether patients with SMI (depression and schizophrenia) and comorbid CMCs experience greater discontinuity of prescribing than patients with CMCs alone.
  
  
  
  2009 Medicaid data were used to compare number and types of prescribers (primary care, cardiometabolic, psychiatric, other) in individuals with 1-3 CMCs (diabetes, hypertension, dyslipidemia) alone (n=76.451); with CMC and schizophrenia (n=6507); and with CMC and depression (n=23.510) and the degree of prescribing within a provider's area of specialty.
  
  
  
  44%, 61%, and 71% of individuals with CMCs only, with CMCs and schizophrenia, and with CMCs and depression had medications from these classes prescribed by 5 or more providers respectively. >35% of patients with CMCs alone or CMCs and schizophrenia had prescriptions provided by 3 or more PCP providers, which increased to 49.1% for patients with CMCs and depression. In the schizophrenia cohort, 29% of antipsychotics were PCP-prescribed while psychiatrists prescribed 10%, 9%, and 9% of antihypertensive, antihyperlipidemic, and antidiabetic medications respectively.
  
  
  
  The presence of SMI increases the number of prescribers treating individuals with CMCs. The impact of this fragmentation in medication management on health outcomes is unknown.
authors.affiliation: UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, USA. Electronic address: jffarley@unc.edu.
authors.forename: Joel F
authors.initials: JF
authors.lastname: Farley
authors.affiliation: Harrison School of Pharmacy, Auburn University, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Hansen
authors.affiliation: Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA.
authors.forename: Marisa E
authors.initials: ME
authors.lastname: Domino
authors.affiliation: UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, USA.
authors.forename: Mrudula
authors.initials: M
authors.lastname: Borse
authors.affiliation: UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, USA.
authors.forename: Nirosha
authors.initials: N
authors.lastname: Mahendraratnam
authors.affiliation: Center for Medication Optimization through Practice and Policy, University of North Carolina at Chapel Hill, USA.
authors.forename: Neepa
authors.initials: N
authors.lastname: Ray
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, USA; Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, USA.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Maciejewski
mesh_terms: D000293:Adolescent; D000328:Adult; D002908:Chronic Disease / Q000188:drug therapy* / Q000453:epidemiology; D015897:Comorbidity; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy* / Q000453:epidemiology; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D012559:Schizophrenia / Q000188:drug therapy* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Chronic disease; Continuity of care; Diabetes; Hypertension; Mental health