Schizophrenia Bulletin Advance Access published online on August 20, 2008
Schizophrenia Bulletin, doi:10.1093/schbul/sbn106
Does Adherence to Medications for Type 2 Diabetes Differ Between Individuals With Vs Without Schizophrenia?
2 Division of Services Research, Department of Psychiatry, University of Maryland School of Medicine, 737 W Lombard Street, 5th floor, Baltimore, MD 21201
3 VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, MD
4 VA Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, MI
5 Department of Psychiatry
6 Department of Health Management and Policy, University of Michigan, Ann Arbor, MI
1 To whom correspondence should be addressed; tel: 410-605-7466, fax: 410-605-7739, e-mail: jkreyenb{at}psych.umaryland.edu.
Individuals with schizophrenia are at increased risk for poor health outcomes and mortality. This may be due to inadequate self-management of co-occurring conditions, such as type 2 diabetes. We compared adherence to oral hypoglycemic medications for diabetes patients with vs without comorbid schizophrenia. Using Veterans Affairs (VA) health system administrative data, we identified all patients with both schizophrenia and type 2 diabetes and with at least one oral hypoglycemic prescription fill in fiscal year 2002 (N = 11 454) and a comparison group of patients with diabetes who were not diagnosed with schizophrenia (N = 10 560). Nonadherence was operationalized as having a medication possession ratio indicating receipt of less than 80% of needed hypoglycemic medications. Poor adherence was less prevalent among diabetes patients with (43%) than without schizophrenia (52%, P < .001). In multivariable analyses, having schizophrenia was associated with a 25% lower likelihood of poor adherence compared with not having schizophrenia (adjusted odds ratio: 0.75, 95% confidence interval: 0.70–0.80). Poorer adherence was associated with black race, homelessness, depression, substance use disorder, and medical comorbidity. Having more outpatient visits, a higher proportion of prescriptions delivered by mail, lower prescription copayments, and more complex medication regimens were each associated with increased adherence. Among veterans with diabetes receiving ongoing VA care, overall hypoglycemic medication adherence was low, but individuals with comorbid schizophrenia were more likely to be adherent to these medications. Future studies should investigate whether factors such as comanagement of a chronic psychiatric illness or regular contact with mental health providers bestow benefits for diabetes self-management in persons with schizophrenia.
Keywords: co-occurring medical conditions / administrative data