Objective: Mentally ill persons represent a population that is potentially vulnerable to poorer quality of medical care. This study examines the relationship between mental disorders and quality of diabetes care in a national sample of veterans.
Methods: Chart-abstracted quality data were merged with outpatient and inpatient administrative database records for a sample of veterans with diabetes who had at least three outpatient visits in the previous year (N=38,020). Mental health diagnoses were identified using the administrative data. Quality of diabetes care was assessed using five indicators: chart documentation of annual foot inspection, pedal pulses examination, foot sensory examination, retina examination, and glycated hemoglobin determination.
Results: Approximately a quarter of the sample had a diagnosed mental disorder (23.7% psychiatric disorder only, 1.3% substance use disorder only, and 2.6% dual diagnosis). Compared with national benchmarks, overall rates of receipt for the indicators were high, ranging from 70.8% for retina examination to 95.0% for foot inspection. Rates for both foot sensory examination and retina examination differed significantly by mental health status, with the lowest rates being among those with a substance use disorder. The associations remained significant in multivariate generalized estimating equation (GEE) analyses that controlled for demographic characteristics, health status, use of medical services, and hospital-level characteristics.
Conclusions: While rates for secondary prevention of diabetes were generally high at Department of Veterans Affairs medical centers, patients with mental disorders (particularly substance use disorders) were less likely to receive some of the recommended interventions, putting them at risk for diabetes-related complications and disability.
Learning Objectives: N/A
Keywords: Mental Illness, Diabetes
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.