Newly published research: mental health affects diabetes care

By Heather Reifsnyder

The mental health of Medi-Cal patients diagnosed with diabetes can adversely affect the quality of diabetes care they obtain, according to new research out of Loma Linda University published in the July issue of the Journal of General Internal Medicine.

An increased risk of diabetes and sub-optimal diabetes care is often linked with serious mental illness. By assessing diabetes prevalence and care among Medi-Cal patients treated through the County of San Bernardino Department of Behavioral Health, the researchers determined that receiving poorer diabetes care was associated with:

• more serious psychiatric symptoms
• treatment with second-generation antipsychotic (SGA) prescription drugs, and
• receiving psychiatric care solely in public mental health clinics.

Diabetes care was measured by whether patients were receiving hemoglobin testing, lipid testing, and eye examinations—tests that experts recommend at least once yearly for those with diabetes.

Medi-Cal mental health services are separately funded and operationally independent of physical health services, meaning that patients who need both must seek care in two systems.

“Unfortunately, patients having both physical and mental health problems, especially if they have more serious mental illness, are going to be less likely to initiate and follow through on routine diabetes care and may be considered as difficult primary care patients,” notes Jim Banta, PhD, MPH, lead researcher and assistant professor in the department of health policy and management at the School of Public Health.

The study found that when patients received psychiatric care from a fee-for-service psychiatrist—as opposed to only in a mental health clinic—they also received better diabetes care, even though that diabetes care was probably from a different doctor. Unfortunately, the data was not able to tell why there was a difference.

One of the practical implications of the study is that extra effort must be spent to ensure that patients on SGA medications receive necessary medical screenings at least once a year.

“The fact that these patients are less likely to get screenings shows that they are slipping through the cracks,” says Dr. Banta. “Just because they have mental health problems, these Medi-Cal patients shouldn’t be put at higher risk for blindness, organ damage, and premature death due to potentially lower quality primary care.”

In addition to Dr. Banta, the other study authors were Scott W. Lee, MD, of the department of internal medicine at Loma Linda University School of Medicine; Mark G. Haviland, PhD, of the department of psychiatry at Loma Linda University School of Medicine; and Elaine H. Morrato, DrPH, MPH, of the department of health systems, management, and policy, Colorado School of Public Health, University of Colorado, Denver, and department of clinical pharmacy, School of Pharmacy, University of Colorado, Denver.

"Eight years ago as both a statistician in the San Bernardino County Department of Behavioral Health and a doctoral student at UCLA, I was intrigued by the idea of merging mental and physical health data to study the total health of psychiatric patients,” says Dr. Banta. “After obtaining a grant from the Loma Linda University School of Public Health and official permission from four different government entities to get such data, it is very gratifying to work with a good team and after much effort to finally see results published in a respectable medical journal."

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