Effect of a Mental Health "Carve-Out" Program on the Continuity of Antipsychotic Therapy

Effect of a Mental Health "Carve-Out" Program on the Continuity of Antipsychotic Therapy,Wayne A. Ray,James R. Daugherty,Keith G. Meador

Effect of a Mental Health "Carve-Out" Program on the Continuity of Antipsychotic Therapy   (Citations: 14)
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background On July 1, 1996, as a cost-containment strategy, Tennessee's expanded Medicaid pro- gram, TennCare, rapidly shifted the provision of mental health services to a fully capi- tated, specialty "carve-out" program, TennCare Partners. We studied the effect of this transition on the continuity of antipsychotic therapy among patients with severe men- tal illness who had previously adhered to treatment. methods Study patients were 21 to 64 years of age, were enrolled throughout the study period, and had adhered to antipsychotic therapy during a 6-month base-line period that pre- ceded the 12 months of study follow-up. The study population included 4507 patients whose follow-up began on the day the change was implemented (the post-transition cohort) and 3644 patients whose follow-up began one year earlier (the pretransition cohort). We compared the two cohorts in terms of the loss of continuity of antipsychot- ic therapy (missed treatment for more than 60 days during follow-up) and the mean number of days of antipsychotic therapy during follow-up. results As compared with the pretransition cohort, the post-transition cohort had increased odds of loss of continuity (a multivariate odds ratio of 1.18 (95 percent confidence in- terval, 1.07 to 1.30), P = 0.001) and a shorter mean duration of antipsychotic therapy (a mean reduction of 4.2 days (95 percent confidence interval, 1.7 to 6.7), P=0.001) dur- ing follow-up. This difference was most pronounced among high-risk patients (those requiring the administration of extended-release (depot) injections of antipsychotic medications or who had been hospitalized for psychosis) at base line, for whom conti- nuity was most important (odds ratio for loss of continuity, 1.79 (95 percent confidence interval, 1.45 to 2.22); P<0.001; mean reduction in the number of days of antipsychotic therapy, 14.4 days (95 percent confidence interval, 9.4 to 19.4); P<0.001). These pa- tients had decreased use of antipsychotic drugs immediately after the transition; the lower level persisted throughout the 12 months of follow-up. conclusions These findings underscore the need to ensure that shifts to widely used carve-out pro- grams, which are designed primarily to contain costs, do not adversely affect clinical outcomes. abstract
Published in 2010.
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