Follow-up Care among Medicaid Patients with Schizophrenia treated with Antipsychotics in the Inpatient Setting

Background: For patients with schizophrenia, the transition from inpatient hospitalization to outpatient care presents a challenge to providing continuous care. Lapses in care during this time period can result in poor clinical outcomes. To date, there is little information regarding the association between inpatient antipsychotic treatment and outpatient care. Objectives: The objectives of this study were to describe trends in and identify factors associated with post-discharge follow-up outpatient care among Medicaid enrollees with schizophrenia treated with antipsychotics. Methods: Adults administered oral or long-acting injectable antipsychotic medication during a hospitalization for schizophrenia were identified in the linked MarketScan® Hospital Drug and Multi-State Medicaid Databases. Psychiatric-related follow-up outpatient visits within 30 days of discharge were identified from Medicaid claims based on Healthcare Effectiveness Data and Information Set specifications. Kaplan-Meier curves and Cox proportional hazards models were used to describe and analyze time to follow-up visit and to identify patient and hospitalization characteristics associated with follow-up visit. Results: The study sample (N=1,312) had a mean age of 40.5 years and was 57% male. A follow-up outpatient visit was identified among 47% of patients. The proportion of patients with a follow-up visit ranged from 25% in 2005 to 48% in 2010/2011. The Cox proportional hazard model suggests that capitated health plan, attending physician specialty of psychiatry/psychology, and later year of index hospitalization significantly increase the probability of a follow-up visit, while substance-related disorders significantly decrease the probability. Type of antipsychotic received during index hospitalization was not significantly associated with probability of a follow-up visit. Conclusion: While follow-up visit rates have increased over time, this study highlights the ongoing need for improvements in effective linkage to outpatient care for patients hospitalized and treated for schizophrenia, particularly among patients with comorbid substance abuse disorder.