Continuity of Medication Management in Medicaid

医疗补助中药物管理的连续性

• 批准号: 8727211
• 负责人: Joel F. Farley
• 金额: $ 37.57万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-01 至 2016-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8727211
• 关键词: Continuity; Medication; Management; Medicaid

DESCRIPTION (provided by applicant): Comorbid cardiometabolic health conditions are a significant burden to the health of patients with schizophrenia representing a major source of morbidity and mortality. Despite their burden, there is evidence to suggest that providers poorly manage comorbid problems in patients with schizophrenia. One oft-cited reason for this mismanagement is poor care coordination between psychiatric specialists treating the mental health needs of patients and primary care providers managing other symptoms. For patients taking medications to manage schizophrenia and comorbid health conditions, poor care coordination can result in inappropriate prescribing, duplication of medication therapy, medication non-adherence, and more aggressive health service utilization for high expenditure intensive resources such as inpatient hospitalizations and emergency room encounters. This study extends upon prior work performed by the research team to better understand continuity of medication management (COMM) in a Medicaid population across multiple care settings and the role that a severe mental health condition (schizophrenia) has on COMM. The first aim of this study is to examine the number and types of prescribers providing medications for Medicaid patients with one or more cardiometabolic conditions and the influence of schizophrenia on this relationship. This aim will identify the extent of the number of providers and types of providers involved in patient care to target care coordination opportunities. The second aim will compare medication adherence and health service utilization in patients with schizophrenia and one or more cardiometabolic health conditions receiving comanagement by a single psychiatrist and single primary care provider to patients using multiple psychiatric providers and/or multiple primary care providers. The results of this aim will examine the influence of comanagement between psychiatrists and PCPs on health outcomes in comparison to poor comanagement by multiple providers potentially duplicating treatment. The final study aim will examine the effect o the medical home at improving health outcomes among patients that are comanaged in aim 2. Patients will be included in the study if they have 2 or more of the following chronic health conditions: hypertension, hyperlipidemia, diabetes, and/or schizophrenia. Specific comparisons will be made between patients with a chronic cardiometabolic health condition with and without schizophrenia. The study uses Medicaid Analytical eXtract (MAX) claims data for 4 states with well validated prescriber information in prescription claims (Colorado, Kentucky, North Carolina, and Vermont) to address these questions. Medication adherence will be assessed using the Medication Possession Ratio for each of the medication classes used and health service utilization comparisons will be limited to high intensive services (inpatient admissions and emergency department visits). This study will improve our understanding of medication care coordination, the role of mental health in care coordination, and the benefits of the medical home model at improving care for patients with multiple chronic conditions.

描述（由申请人提供）：合并症的心脏代谢健康状况是精神分裂症患者健康的重大负担，是发病率和死亡率的主要来源。尽管他们有负担，但有证据表明，医疗服务提供者对精神分裂症患者的合并症管理不善。这种管理不善的一个经常被引用的原因是治疗患者心理健康需求的精神病专家和管理其他症状的初级保健提供者之间的护理协调不力。对于服用药物治疗精神分裂症和合并症的患者，不良的护理协调可能导致处方不当、药物治疗重复、药物依从性不佳，以及更积极地利用高支出密集型资源（如住院和急诊室就诊）的卫生服务。本研究是在研究团队先前工作的基础上进行的扩展，旨在更好地了解医疗补助人群在多种护理环境中的药物管理连续性（COMM），以及严重精神健康状况（精神分裂症）对COMM的影响。本研究的第一个目的是检查为患有一种或多种心脏代谢疾病的医疗补助患者提供药物的处方者的数量和类型，以及精神分裂症对这种关系的影响。这一目标将确定数量的提供者和类型的提供者参与病人护理的目标护理协调机会的程度。第二个目的是比较精神分裂症患者和接受单一精神科医生和单一初级保健提供者管理的一种或多种心脏代谢疾病患者与接受多个精神科医生和/或多个初级保健提供者管理的患者的药物依从性和卫生服务利用情况。这一目标的结果将检验精神科医生和pcp之间的管理对健康结果的影响，并将其与多个提供者可能重复治疗的不良管理进行比较。最后的研究目标将检验医疗之家在改善目标2中管理的患者的健康结果方面的作用。如果患者有以下两种或两种以上的慢性健康状况：高血压、高脂血症、糖尿病和/或精神分裂症，他们将被纳入研究。将对患有慢性心脏代谢疾病并伴有和不伴有精神分裂症的患者进行具体比较。该研究使用了4个州的医疗补助分析提取（MAX）索赔数据，这些数据在处方索赔中具有良好验证的处方信息（科罗拉多州、肯塔基州、北卡罗来纳州和佛蒙特州）来解决这些问题。将使用所使用的每种药物类别的药物持有率来评估药物依从性，卫生服务利用情况的比较将限于高重症服务（住院和急诊就诊）。本研究将增进我们对药物护理协调、心理健康在护理协调中的作用以及医疗之家模式在改善多重慢性疾病患者护理方面的益处的理解。

项目成果

Continuity of medication management in Medicaid patients with chronic comorbid conditions: An examination by mental health status.

患有慢性合并症的医疗补助患者的药物管理连续性：心理健康状况检查。

• DOI: 10.1016/j.genhosppsych.2016.12.001
• 发表时间: 2017
• 期刊: General hospital psychiatry
• 影响因子: 7
• 作者: Farley,JoelF;Hansen,RichardA;Domino,MarisaE;Borse,Mrudula;Mahendraratnam,Nirosha;Ray,Neepa;Maciejewski,MatthewL
• 通讯作者: Maciejewski,MatthewL