Regular Primary Care Associated with Better Survival Rates for Veterans with Schizophrenia and Diabetes
Medical comorbidity among aging people with schizophrenia is common. For example, in 2002 nearly 670,000 Veterans older than 50 received VA care for diabetes, including 13,000 with schizophrenia. But many patients with schizophrenia have difficulty managing their medical healthcare needs, which may result in delayed treatment and poor outcomes. In fact, excess mortality has been documented among patients with schizophrenia, with some studies indicating up to a 25-year shorter lifespan. This retrospective cohort study assessed whether patterns of VA primary care use among Veterans with diabetes (n=188, 332), schizophrenia (n=40,109), or both (n=13,025) were a significant predictor of mortality over the study period (FY02-FY05). Using VA administrative data, investigators examined comorbidity, mortality, and primary care use.
Findings show that regular primary care and high levels of primary care were associated with better survival for patients with chronic illness, whether psychiatric or medical. For example, increasing use of primary care was least common among Veterans with schizophrenia only (4%) compared with Veterans with diabetes only (7%), or those with both conditions (8%), – and was associated with improved survival. This suggests that innovations in treatment retention targeting at-risk groups can offer significant promise of improving outcomes.
Copeland L, Zeber J, Wang C, Parchman M, Lawrence V, Valenstein M, and Miller A. Patterns of primary care and mortality among patients with schizophrenia or diabetes: A cluster analysis approach to the retrospective study of healthcare utilization. BMC Health Services Research July 26, 2009;9(1):127. E-pub ahead of print.
This study was funded by HSR&D. Drs. Copeland, Zeber, Wang, Parchman, and Lawrence are part of HSR&D’s Veterans Evidence-Based Research Dissemination and Implementation Center in San Antonio, TX.