Associations between mental health and diabetes: findings from the South Carolina Medicaid managed care program in 2006-2008

Abstract

Objectives: To assess differences in services associated with mental health status and prescriptions among Medicaid patients diagnosed with diabetes mellitus.

Design: Secondary data analyses of South Carolina (SC) Medicaid enrollees.

Participants: SC Medicaid enrollees with a diagnosis of diabetes mellitus (N = 555) continuously enrolled in either managed care (MC) or fee for service (FFS) programs between 2006 and 2008.

Main outcome measures: Health Plan Employer Data and Information Set (HEDIS)-based diabetes management service outcomes including: 1) whether the recipient received a nephrology exam; 2) the number of eye exams received; 3) the number of low-density lipoprotein cholesterol services received; and 4) the number of Hemoglobin A1c blood tests conducted. Outcomes were fitted to regression models adjusting for sex, race, health program provider type (MC or FFS), rurality, poverty indexes, clinical risk group status, whether there was a female head of household, and indicators for classes of prescription pharmaceuticals (antipsychotics, antidepressants, and anticonvulsants).

Results: There are significant differences in the incidence of diabetes management service-use between enrollees in management plans and between recipients of classes of pharmaceuticals and mental health status. Enrollees in FFS have fewer claims associated with diabetes management services compared to counterparts in MC.

Conclusions: Our early findings demonstrate the importance of efforts to collect HEDIS measures data and their potential as a resource for assessing quality of care. More importantly, this study illustrates the association between mental health status and associated pharmaceutical prescriptions.