Measurement of Metabolic Monitoring in Youth and Adult Medicaid Recipients Prescribed Antipsychotics.

Background: Individuals being treated with first- and second-generation antipsychotics (FGAs and SGAs) are at risk for a variety of adverse cardiometabolic effects. Although consensus guidelines that recommend metabolic monitoring for patients receiving SGAs have been in place since 2004, the rate of monitoring remains low, especially in the pediatric population.

Objectives: To (a) examine differences in rates of laboratory monitoring for glucose and lipids for adults and youth prescribed FGAs and SGAs; (b) look at factors associated with the likelihood of metabolic testing; and (c) describe cohort effects that may have had an impact on the rates of laboratory testing. 

Methods: This is a retrospective study examining the rates of glucose and lipid testing for 3 separate cohorts of Medicaid recipients who were prescribed antipsychotics during 3 measurement periods-2008, 2010, and 2012-using paid Medicaid pharmacy and laboratory claims data. The sample included adults aged 18 years and older and children aged 17 years and younger. For each measurement period, we identified the rate of metabolic monitoring and the demographic characteristics for each individual, including race, age, and gender. The proportion of laboratory monitoring was assessed using chi square tests for each of the outcomes. Logistic regression models for each time point were used to determine the characteristics of individuals who were more likely to receive monitoring.

Results: The proportion of individuals receiving glucose and lipid tests increased for both age groups across all measurement periods. For individuals aged 18 years and over, glucose monitoring increased from 56.6%-72.6%. Testing for lipids remained constant, ranging from 38.3%-41.2% for each of the 3 measurement periods. During the first measurement period, in 2008, females were 41% and 15% more likely to receive glucose and lipid laboratory monitoring, respectively, compared with males. Females continued to be more likely to receive glucose monitoring during the measurement periods in 2010 and 2012, although there was no significant difference between females and males for lipid monitoring during these time periods. Individuals aged 17 years and younger were 59%-68% less likely to receive glucose monitoring than adults (aged ≥ 18 years) for all time points. Across all measurement periods, individuals aged ≤ 17 years were also 44%-58% less likely to receive lipid monitoring compared with adults (aged ≥ 18 years). While there was no significant difference between Caucasians and non-Caucasians in the first measurement period, Caucasians were about 30% less likely to receive glucose monitoring and about 50% less likely to receive lipid monitoring during the measurement periods covering 2010 and 2012.  

Conclusions: Metabolic monitoring in adults improved substantially over the time periods studied; however, rates remained suboptimal, especially in the pediatric population. This finding suggests that interventions to increase metabolic monitoring in adults and children using FGAs and SGAs are necessary.