Department of Health Systems, Colorado School of Public Health, University of Colorado Denver, Aurora, CO 80045, USA.
Pharmacoepidemiol Drug Saf. 2011 Jan;20(1):66-75. doi: 10.1002/pds.2062. Epub 2010 Nov 15.
The American Diabetes Association and American Psychiatric Association recommend metabolic monitoring for all patients using second-generation antipsychotic (SGA) drugs. We estimated glucose and lipid testing rates among SGA-users from three state Medicaid programs and investigated small area variation and patient and geographic determinants of testing.
A retrospective new-user cohort study using Medicaid claims data from California, Missouri, and Oregon was conducted among 30,563 patients in 207 counties starting SGA medication September 2004-December 2005. Adjusted odds ratios for state, county, and patient factors associated with testing were calculated from multivariable hierarchical logistic regression models.
Mean 6-month testing rates were 51.6% (glucose) and 26.2% (lipids). Screening rates were positively associated with the number of Type 2 diabetes risk factors (RF) present: glucose -39% (0 RF) to 82% (5 RF); lipids -13% (0 RF) to 66% (5 RF). A four-fold difference in glucose testing rates (21-85%) and a greater than six-fold difference in lipid testing rates (0-62%) were observed between counties. In the adjusted regression models, age, cardiometabolic co-morbidity (diabetes, dyslipidemia), serious mental illness, persistent use of SGAs, and frequency of non-psychiatric medical office visits were significant determinants of glucose and lipid testing. Lipid testing was more likely for children and adults in California, as was glucose testing for children.
Glucose and lipid testing among SGA-users varied significantly between states, counties, and by patient characteristics. More effort is needed to understand provider and system reasons for testing disparities in order to inform risk management quality improvement interventions.
美国糖尿病协会和美国精神病学协会建议对所有使用第二代抗精神病药物（SGA）的患者进行代谢监测。我们估计了三个州的医疗补助计划中的 SGA 用户的血糖和血脂检测率，并调查了小区域差异以及患者和地理因素对检测的影响。
使用加利福尼亚州、密苏里州和俄勒冈州的医疗补助索赔数据，对 2004 年 9 月至 2005 年 12 月期间开始使用 SGA 药物的 30563 名患者进行了回顾性新用户队列研究。使用多变量层次逻辑回归模型计算与检测相关的州、县和患者因素的调整后优势比。
平均 6 个月的检测率分别为 51.6%（血糖）和 26.2%（血脂）。筛查率与存在的 2 型糖尿病风险因素（RF）的数量呈正相关：血糖-39%（0 RF）至 82%（5 RF）；血脂-13%（0 RF）至 66%（5 RF）。在县之间观察到血糖检测率（21-85%）的四倍差异和血脂检测率（0-62%）的六倍以上差异。在调整后的回归模型中，年龄、心脏代谢合并症（糖尿病、血脂异常）、严重精神疾病、持续使用 SGA 和非精神科医疗就诊次数是血糖和血脂检测的重要决定因素。加利福尼亚州的儿童和成年人更有可能进行血脂检测，而儿童则更有可能进行血糖检测。
SGA 用户的血糖和血脂检测在各州、各县以及患者特征之间存在显著差异。需要进一步努力了解提供者和系统进行检测差异的原因，以便为风险管理质量改进干预措施提供信息。
