Quality of monitoring for metabolic effects associated with second generation antipsychotics in patients with schizophrenia on public insurance.

Second generation antipsychotics (SGA) are associated with new onset diabetes, dyslipidemia and significant weight gain. Patients with schizophrenia are also at an increase risk of developing metabolic disorders, making routine metabolic monitoring important in patients with schizophrenia. The objective of our study was to identify glucose and lipid monitoring rates in Kansas Medicaid beneficiaries with schizophrenia who received long-term SGA therapy both before and after metabolic concerns of SGA had been introduced in the medical literature and after publication of metabolic monitoring guidelines from professional organizations in 2004. A retrospective cohort study was conducted using health care claims of Kansas Medicaid enrollees (age 18-64 years) with a diagnosis of schizophrenia and receiving long-term SGA. Proportions of these patients receiving annual blood glucose and serum lipid laboratory tests were calculated for two periods: 2002-2003 and 2005-2007. Bivariate and multivariate analyses were conducted to determine associations between demographic characteristics and monitoring outcomes. Among 2204 persons in the 2002 cohort, 23% received annual blood glucose monitoring and 10.1% received lipid monitoring. Among 1646 persons in the 2006 cohort, 75.3% received blood glucose monitoring and 52.5% received lipid monitoring. Our findings showed significant increases in blood glucose and lipid monitoring rates observed across a 4-year period in Kansas Medicaid enrollees with schizophrenia receiving SGA. The large rise in monitoring over time may be due to increase awareness of metabolic concerns by mental health care specialists, whom patients with schizophrenia are likely to receive their care from.