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Kilbourne AM (VA Ann Arbor HSRD), Welsh D
(VA Ann Arbor HSRD), McCarthy JF
(VA Ann Arbor HSRD), Post EP
(VA Ann Arbor HSRD), Blow FC
(VA Ann Arbor HSRD)
Objectives:
Cardiovascular disease (CVD) is common and a leading cause of mortality among veterans with serious mental illness (SMI). Undertreatment of CVD-related conditions may lead to adverse outcomes in patients with SMI and other mental disorders. We compared quality of care for CVD-related conditions among VA patients with versus without comorbid mental disorders.
Methods:
We identified all patients included in the fiscal year 2005 (FY05) VA External Peer Review Program’s (EPRP) national random sample of chart reviews for assessing quality of care for CVD-related conditions. Using the VA’s National Psychosis Registry and the National Registry for Depression, we assessed whether patients had received diagnoses of serious mental illness (schizophrenia, bipolar disorder, or other psychoses) or depression during FY05. Using multivariable logistic regression and generalized estimating equation analyses, we assessed patient and facility factors associated with receipt of guideline concordant care for hypertension, hyperlipidemia, and diabetes.
Results:
Overall, 70% had good blood pressure control, 48% had an LDL of > 120 mg/ml (poor control), 77% received a retinal exam for diabetes, and 63% received recommended renal tests for diabetes. After adjustment, compared to patients without SMI or depression, patients with SMI were less likely to be assessed for CVD risk factors, notably hyperlipidemia (N=3,948; OR=0.68;p < .001), and less likely to receive recommended follow-up assessments for diabetes: foot exam (N=8,981; OR=0.75;p < .001), eye exam (OR=0.80;p < .01), or renal testing (OR=0.75;p < .001). Patients with depression were also significantly less likely to receive adequate quality of care compared to non-psychiatric patients, although effects were smaller than observed for patients with SMI.
Implications:
Quality of care for major chronic conditions associated with premature mortality is suboptimal for VA patients with SMI, especially for procedures requiring care by a specialist. Patients with SMI are at particularly high risk for suboptimal care.
Impacts:
Concerns regarding treatment for CVD-related conditions among patients with mental illnesses are of particular policy importance given increased use of atypical antipsychotic medications, which are associated with CVD risk factors such as weight gain and diabetes. Providers and healthcare leaders should consider efforts to improve access and continuity of care for general medical treatment for veterans with mental illnesses.
