Table 2.
Measures of screening for cardiovascular risk factors in persons with serious mental illness, 2000-2013
| Study population | Main finding in words | References |
|---|---|---|
| Panel 1: Screening for Overweight and Obesity | ||
| Body Mass Index | ||
| N: 40600 | % of study sample with schizophrenia or bipolar disorder: 100% | Percent antipsychotic users: 100% | Study population: Outpatient Veterans participating in the National Psychosis Registry, | Screening year(s): 2007 | Time window for ascertaining screening rate: Bi-annual | Data source: Administrative claims | 76% of patients had Body Mass Index (BMI) assessed in 2007 | Kilbourne, 2011 [22] |
| Panel 2: Screening for Diabetes Mellitus | ||
| Glucose screening | ||
| N: 55436 | % of study sample with schizophrenia or bipolar disorder: 100% | Percent antipsychotic users: 100% | Study population: Inpatient and Outpatient Medicaid beneficiaries from California, Oregon, Tennessee and Utah | Screening year(s): 1998–2003 | Time window for ascertaining screening rate: 14 days prior-28 days after second generation antipsychotic initiation | Data source: Administrative claims | 18% of those without schizophrenia and 23% of those with schizophrenia had a glucose test during 1998-2003 | Morrato, 2008 [25] |
| Compared to those without schizophrenia, those with schizophrenia had 1.5 times greater odds of having a glucose test during 1998–2003 (p < .05) | ||
| N: 18876 | % of study sample with schizophrenia or bipolar disorder: 3.4% schizophrenia and 49.3% mood disorders, including bipolar disorder | Percent antipsychotic users: 100% | Study population: Inpatient and outpatient commercial health insurance beneficiaries | Screening year(s): 2001–2006 | Time window for ascertaining screening rate: 30 days prior-30 days after second generation antipsychotic initiation | Data source: Administrative claims | The mean glucose testing rate for antipsychotic-treated patients was 23% during 2001-2006 | Morrato, 2009 [27] |
| N: 2204 | % of study sample with schizophrenia or bipolar disorder: 100% | Percent antipsychotic users: 100% | Study population: Inpatient and outpatient Kansas Medicaid beneficiaries | Screening year(s): 2003 | Time window for ascertaining screening rate: Annual | Data source: Administrative claims | 23% of patients had a glucose test during 2002-2003 | Moeller, 2011 [26] |
| 29% of patients with dyslipidemia had a glucose test during 2002-2003 | ||
| N: 1646| % of study sample with schizophrenia or bipolar disorder: 100% | Percent antipsychotic users: 100% | Study population: Inpatient and outpatient Kansas Medicaid beneficiaries| Screening year(s): 2005-2007| Time window for ascertaining screening rate: Annual | Data source: Administrative claims | 75% of patients had a glucose test during 2005-2007 | |
| 65% of patients with dyslipidemia had a glucose test during 2005-2007 | ||
| N: 6601 | % of study sample with schizophrenia or bipolar disorder: Not reported | Percent antipsychotic users: 100% | Study population: Inpatient and outpatient California Medicaid recipients | Screening year(s): 2004-2005| Time window for ascertaining screening rate: Six months prior to-6 months after second generation antipsychotic initiation| Data source: Administrative claims | 24% of patients had a glucose test in the six months prior to antipsychotic initiation during 2004-2005 | Barnett, 2010 [32] |
| 28% of patients had a glucose test in the six months after antipsychotic initiation during 2004-2005 | ||
| N: 40600 | % of study sample with schizophrenia or bipolar disorder: 100% | Percent antipsychotic users: 100% | Study population: Outpatient Veterans participating in the National Psychosis Registry | Screening year(s): 2007 | Time window for ascertaining screening rate: Bi-annual | Data source: Administrative claims | 60% of patients had at least two glucose tests in 2007 | Kilbourne, 2011 [22] |
| Glucose and Lipids Screening | ||
| N: 6601 | % of study sample with schizophrenia or bipolar disorder: Not reported | Percent antipsychotic users: 100% | Study population: Inpatient and outpatient California Medicaid recipients | Screening year(s): 2004–2005 | Time window for ascertaining screening rate: Six months prior-6 months after second generation antipsychotic initiation| Data source: Administrative claims | 23% of patients had both a glucose test and a lipid test in the six months prior to antipsychotic initiation during 2004-2005 | Barnett, 2010 [32] |
| 27% of patients had both a glucose test and a lipid test in the six months after antipsychotic initiation during 2004-2005 | ||
| Panel 3: Screening for Dyslipidemia | ||
| Any Lipid Screening | ||
| N: 200 | % of study sample with schizophrenia or bipolar disorder: 75% | Percent antipsychotic users: Not reported | Study population: Outpatients from psychiatric care centers in Baltimore, MD | Screening year(s): 2000 | Time window for ascertaining screening rate: Annual| Data source: Interview data | In 2000, 51% of patients reported having had their cholesterol checked in the past year | Dickerson 2003 [38] |
| N: 55436 | % of study sample with schizophrenia or bipolar disorder: 100% | Percent antipsychotic users: 100% | Study population: Inpatient and Outpatient Medicaid beneficiaries from California, Oregon, Tennessee and Utah | Screening year(s): 1998–2003 | Time window for ascertaining screening rate: 14 days prior-28 days after second generation antipsychotic initiation | Data source: Administrative claims | 6% of those without schizophrenia and 9% of those with schizophrenia had a lipid test during 1998-2003 | Morrato, 2008 [25] |
| Compared to those without schizophrenia, those with schizophrenia had 1.4 times greater odds of having a lipid test during 1998–2003 (p < .05) | ||
| N: 94 | % of study sample with schizophrenia or bipolar disorder: 100% Percent antipsychotic users: Not reported | Study population: Outpatient homeless shelter clinic users | Screening year(s): 1999–2000 | Time window for ascertaining screening rate: Annual | Data source: Medical chart review | 55% of those with schizophrenia had a lipid test during 1999-2000 | Folsom, 2002 [35] |
| N: 408 | % of study sample with schizophrenia or bipolar disorder: 100% | Percent antipsychotic users: 100% | Study population: Inpatient and outpatient Veterans | Screening year(s): 1999–2003 | Time window for ascertaining screening rate: Four years | Data source: Administrative claims | 85% of patients had at least one lipid test during 1999-2003 | Weissman, 2006 [31] |
| 27% of patients had only one lipid test during 1999-2003 | ||
| N: 64,490 | % of study sample with schizophrenia or bipolar disorder: 51% mood disorders, including bipolar disorder| Percent antipsychotic users: Not reported | Study population: Outpatient Veterans from New England Health Care System | Screening year(s): 2000–2001 | Time window for ascertaining screening rate: Annual | Data source: Administrative claims | 85% of patients with mental illness had a lipid test, compared to 78% of patients without mental illness in 2001 | Kaplowitz, 2006 [30] |
| Compared to those without SMI, those with SMI had 2.73 times greater odds of having a lipid test in 2001 (p < .05) | ||
| N: 18876 | % of study sample with schizophrenia or bipolar disorder: 3.4% schizophrenia, 49.3% mood disorders, including bipolar disorder| Percent antipsychotic users: 100% | Study population: Inpatient and outpatient commercial health insurance beneficiaries | Screening year(s): 2001–2006 | Time window for ascertaining screening rate: 30 days prior-30 days after second generation antipsychotic initiation | Data source: Administrative claims | The mean lipid testing rate for antipsychotic-treated patients was 8% during 2001-2006 | Morrato, 2009 [27] |
| N: 2204| % of study sample with schizophrenia or bipolar disorder: 100% | Percent antipsychotic users: 100% | Study population: Inpatient and outpatient Kansas Medicaid beneficiaries | Screening year(s): 2003| Time window for ascertaining screening rate: Annual | Data source: Administrative claims | 10% of patients had a lipid test during 2002-2003 | Moeller, 2011 [26] |
| N: 1646| Diagnoses: Schizophrenia | Percent antipsychotic users: 100% | Study population: Inpatient and outpatient Kansas Medicaid beneficiaries | Screening year(s): 2005–2007 | Time window for ascertaining screening rate: Annual | Data source: Administrative claims | 53% of patients had a lipid test during 2005-2007 | |
| N: 6601 | % of study sample with schizophrenia or bipolar disorder: Not reported| Percent antipsychotic users: 100% | Study population: Inpatient and outpatient California Medicaid recipients | Screening year(s): 2004–2005 | Time window for ascertaining screening rate: Six months prior-6 months after second generation antipsychotic initiation | Data source: Administrative claims | 39% of patients had a lipid test in the six months prior to antipsychotic initiation during 2004-2005 | Barnett, 2010 [32] |
| 43% of patients had a lipid test in the six months after antipsychotic initiation during 2004-2005 | ||
| N: 46,430 | % of study sample with schizophrenia or bipolar disorder: 100% | Percent antipsychotic users: Not reported | Study population: Inpatient or outpatient veterans with hyperlipidemia participating in National Psychosis Registry | Screening year(s): 2005 | Time window for ascertaining screening rate: Annual | Data source: Medical chart review | 90% of those with SMI, 94% of those with depression, and 94% of those without a psychiatric disorder had a lipid test in 2005 (p < .001) | Kilbourne, 2008 [34] |
| N: 40600 | % of study sample with schizophrenia or bipolar disorder: 100% |Percent antipsychotic users: 100% | Study population: Outpatient Veterans participating in the National Psychosis Registry| Screening year(s): 2007 | Time window for ascertaining screening rate: Annual | Data source: Administrative claims | 37% of patients had a lipid test in 2007 | Kilbourne, 2011 [22] |
| Low Density Lipoprotein (LDL) Screening | ||
| N: 408 | % of study sample with schizophrenia or bipolar disorder: 100% | Percent antipsychotic users: 100% | Study population: Inpatient and outpatient Veterans | Screening year(s): 1999–2003 | Time window for ascertaining screening rate: four years| Data source: Administrative claims | 74% of patients had at least one LDL test during 1999-2003 | Weissman, 2006 [31] |
| 28% of patients had only one LDL test during 1999-2003 | ||
| Triglyceride Screening | ||
| N: 408 | % of study sample with schizophrenia or bipolar disorder: 100% | Percent antipsychotic users: 100% | Study population: Inpatient and outpatient Veterans | Screening year(s): 1999–2003 | Time window for ascertaining screening rate: four years | Data source: Administrative claims | 85% of patients had at least one triglycerides test during 1999-2003 | Weissman, 2006 [31] |
| 27% of patients had only one triglycerides test during 1999-2003 | ||
| Panel 4: Screening for Hypertension | ||
| Any Blood Pressure Assessment | ||
| N: 200 | % of study sample with schizophrenia or bipolar disorder: 75%| Percent antipsychotic users: Not reported | Study population: Outpatients from psychiatric care centers in Baltimore, MD | Screening year(s): 2000 | Time window for ascertaining screening rate: Annual| Data source: Interview data | In 2000, 88% of patients reported having had their blood pressure checked in the past year | Dickerson 2003 [38] |
| N: 40600 | % of study sample with schizophrenia or bipolar disorder: 100% |Percent antipsychotic users: 100% | Study population: Outpatient Veterans participating in the National Psychosis Registry | Screening year(s): 2007 | Time window for ascertaining screening rate: Annual | Data source: Administrative claims | 79% of patients had blood pressure assessed in 2007 | Kilbourne, 2011 [22] |