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Follow-Up Visits after Hospital Discharge for Schizophrenia


Tim Casey

San Francisco—Within 30 days of hospital discharge, approximately one third of patients with schizophrenia who had Medicaid or private health insurance failed to have a follow-up visit, according to a retrospective, longitudinal cohort analysis. Patients who had not received mental health care in the 90 days before hospital admission were at the highest risk of not having a follow-up visit within 30 days of discharge.

Results were presented during a poster session at the APA meeting. The poster was titled Follow-Up after Hospitalization for Schizophrenia for Patients with Medicaid or Commercial Insurance.

The authors noted that a previous study found 40% of adults with schizophrenia in a Medicaid program did not receive outpatient mental health care during the 30 days after discharge. They said that the period following discharge is a vulnerable time for patients to recover from system exacerbations and added that the risk of relapse is increased if patients discontinue treatment.

For Medicaid, Medicare, and commercial plans, the National Committee for Quality Assurance has developed a metric, Follow-up Care after Hospitalization for Mental Illness, which is included in the Healthcare Effectiveness Data and Information Set quality measurements. However, the authors mentioned there are few data evaluating the continuity of care after patients with Medicaid and commercial insurance are discharged from the hospital.

In this study, the authors examined the Truven Health MarketScan® Medicaid multistate database from 2007 to 2010, as well as the PharMetrics Integrated Database from IMS Health from 2007 to 2010. Patients were included if they were between 18 and 64 years of age on the day they were discharged, were enrolled continuously in a health plan in the 30 days after discharge and the 90 days before being admitted to the hospital, and had a hospital admission with a primary diagnosis at discharge of schizophrenia. They were excluded if they were transferred directly from the hospital to another inpatient or acute care facility or if they were readmitted to an inpatient facility within 30 days of hospital discharge.

The study included 3284 privately insured patients and 18,415 Medicaid patients. In the Medicaid group, 52.5% of patients were male compared with 47.8% in the privately insured group (P<.001). The mean length of stay in the hospital was 8.7 days in the Medicaid group and 9.7 days in the privately insured group (P<.001).

Within 30 days of hospital discharge, 66.9% of privately insured patients and 66.3% of Medicaid patients had an outpatient mental health visit (adjusted odds ratio [OR], 0.97; 95% confidence interval [CI], 0.89 to 1.06; P=.54).

If patients had an outpatient mental health visit in the 90 days before hospital admission, they were 7 times more likely to have an outpatient mental health visit within 30 days following discharge compared with patients who did not have a visit in the 90 days prior to admission (adjusted OR, 7.00; 95% CI, 6.03 to 8.12). In addition, compared with patients who took no antipsychotics in the 90 days before admission, those who received at least 2 long-acting injectable antipsychotics (adjusted OR, 1.60; 95% CI, 1.35 to 1.91) or at least 2 oral antipsychotics (adjusted OR, 1.34; 95% CI, 1.24 to 1.46) were more likely to have an outpatient mental health visit in the 30 days after discharge.

The authors cited a few limitations of the study, including that it only included nonelderly Medicaid and privately insured patients and may not be relevant for older and uninsured patients. The claims data also did not include information such as the adequacy of discharge planning and the availability of outpatient mental health services. Further, the claims data may not have accurately reflected all of the clinical diagnoses for the patients, and the results may not be generalizable for patients readmitted within 30 days of discharge.

This study was supported by Janssen Scientific Affairs, LLC.

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