New research shows that despite long-standing recommendations that severely mentally ill patients who take antipsychotics undergo annual screening for diabetes and other metabolic disorders, only 30% receive such screening. A recent research letter in JAMA Internal Medicine described a retrospective cohort study that analyzed diabetes screening prevalence and predictors of screening among adults in the California public mental health care system with severe mental illness taking antipsychotic medications.
The study cohort included adults with a diagnosis of severe mental illness who received a prescription for an antipsychotic medication at least once during each of the study periods. Of 50,915 patients in the study, only 15,315 (30.1%) received diabetes-specific screening. A total of 15,832 (31.1%) received no form of glucose screening at all during the year-long period. The rates for those who received no glucose screening were similar regardless of age (38.4% for patients aged 18 – 27 years; 31.9% for patients aged 28 – 47 years; 26.9% for those aged 48 – 67 years; and 40.9% for those aged 68 years and older). The study noted that contact with primary care improved diabetes screening rates. Patients with severe mental illnesses who had at least one primary care visit in addition to receiving mental health services were more than twice as likely to be screened than those who did not have a primary care visit (35.6% vs 19.8%).
An editorial that accompanied the new study, Mitchell M Katz, MD pointed out that “To improve care for persons with serious mental illness, it will be necessary to break down the silos that separate the mental health and physical health care systems. Integrated care (care provided by a team of physical and mental health clinicians)—or at least colocated care (care provided by physical and mental health clinicians in the same place)—offers the promise of improving the physical health of individuals with mental illness, as well as the mental health of those seeking physical health services.
Mangurian C, Newcomer JW, Vittinghoff E, et al. Diabetes screening among underserved adults with severe mental illness who take antipsychotic medications [published online November 9, 2015]. JAMA Intern Med. doi:10.1001/jamainternmed.2015.6098.
Katz, MH. Improving the Health of Persons With Serious Mental Illness. JAMA Intern Med. Published online November 09, 2015. doi:10.1001/jamainternmed.2015.6159