Abstract
Background: For patients with schizophrenia, the transition from inpatient hospitalization to outpatient care presents a challenge to providing continuous care. Lapses in care during this time period can result in poor clinical outcomes. To date, there is little information regarding the association between inpatient antipsychotic treatment and outpatient care. Objectives: The objectives of this study were to describe trends in and identify factors associated with post-discharge follow-up outpatient care among Medicaid enrollees with schizophrenia treated with antipsychotics. Methods: Adults administered oral or long-acting injectable antipsychotic medication during a hospitalization for schizophrenia were identified in the linked MarketScan® Hospital Drug and Multi-State Medicaid Databases. Psychiatric-related follow-up outpatient visits within 30 days of discharge were identified from Medicaid claims based on Healthcare Effectiveness Data and Information Set specifications. Kaplan-Meier curves and Cox proportional hazards models were used to describe and analyze time to follow-up visit and to identify patient and hospitalization characteristics associated with follow-up visit. Results: The study sample (N=1,312) had a mean age of 40.5 years and was 57% male. A follow-up outpatient visit was identified among 47% of patients. The proportion of patients with a follow-up visit ranged from 25% in 2005 to 48% in 2010/2011. The Cox proportional hazard model suggests that capitated health plan, attending physician specialty of psychiatry/psychology, and later year of index hospitalization significantly increase the probability of a follow-up visit, while substance-related disorders significantly decrease the probability. Type of antipsychotic received during index hospitalization was not significantly associated with probability of a follow-up visit. Conclusion: While follow-up visit rates have increased over time, this study highlights the ongoing need for improvements in effective linkage to outpatient care for patients hospitalized and treated for schizophrenia, particularly among patients with comorbid substance abuse disorder.
Highlights
For patients with schizophrenia, the transition from inpatient hospitalization to outpatient care presents a challenge to providing continuous care
After removing hospitalizations of persons insured through commercial plans or Medicare and applying the hierarchy to select a hospitalization for inclusion, the final study sample was comprised of 1,312 unique patients insured through Medicaid
1,025 patients had only one eligible hospitalization and the hierarchy of choosing an admission based on index drug type was not applied, and 1,022 had a psychiatric diagnosis as the primary diagnosis on the index hospitalization claim, including 938 patients with a primary diagnosis of schizophrenia
Summary
The transition from inpatient hospitalization to outpatient care presents a challenge to providing continuous care. Objectives: The objectives of this study were to describe trends in and identify factors associated with postdischarge follow-up outpatient care among Medicaid enrollees with schizophrenia treated with antipsychotics. Kaplan-Meier curves and Cox proportional hazards models were used to describe and analyze time to follow-up visit and to identify patient and hospitalization characteristics associated with follow-up visit. The Cox proportional hazard model suggests that capitated health plan, attending physician specialty of psychiatry/psychology, and later year of index hospitalization significantly increase the probability of a follow-up visit, while substance-related disorders significantly decrease the probability. Conclusion: While follow-up visit rates have increased over time, this study highlights the ongoing need for improvements in effective linkage to outpatient care for patients hospitalized and treated for schizophrenia, among patients with comorbid substance abuse disorder.
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