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Assessment of monitoring for glucose and lipid dysregulation in adult Medi-Cal patients newly started on antipsychotics

Mitchell Barnett, PharmD, MS

Touro University-California, College of Pharmacy, Vallejo, CA, USA

Shannon VonMuenster, PharmD

Touro University-California, College of Pharmacy, Vallejo, CA, USACenter for California Medicaid (Medi-Cal), Sacramento, CA, USA

Heidi Wehring, PharmD

Touro University-California, College of Pharmacy, Vallejo, CA, USA

Sarah Popish, PharmD

Touro University-California, College of Pharmacy, Vallejo, CA, USA

Karna McDonald, PharmD

Touro University-California, College of Pharmacy, Vallejo, CA, USA

Victor M. Walker, RPh

Center for California Medicaid (Medi-Cal), Sacramento, CA, USA

Paul Perry, PhD

Touro University-California, College of Pharmacy, Vallejo, CA, USA

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).

CONCLUSION: 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.

KEYWORDS: antipsychotic agents, metabolic disorders, type 2 diabetes, dyslipidemia, guideline adherence

ANNALS OF CLINICAL PSYCHIATRY 2010;22(1):9–18

CORRESPONDENCE: Paul J. Perry, PhD, Professor and Chair, Pharmacy Practice Department, Touro-University California, College of Pharmacy, 1310 Johnson Lane, Mare Island, Vallejo, CA 94592 USA, E-MAIL: pjperry2@comcast.net
Annals of Clinical Psychiatry ©2010 American Academy of Clinical Psychiatrists

 
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