Objective: To discern the extent of antipsychotic pharmacotherapy, psychotherapy, and/or mental health counseling among US Medicaid beneficiaries with schizophrenia.
Methods: Data were abstracted from the 2010 US National Ambulatory Medical Care Survey (NAMCS) for all state Medicaid beneficiaries with a diagnosis of schizophrenia (ICD-9-CM codes 295.00-295.99). The US NAMCS is a national cross-sectional probability sample conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention, with data collected by the US Census Bureau. Primary patient characteristics examined were: use of antipsychotics, psychotherapy, and/or mental health counseling.
Results: In 2010, there were 1,353,299 US Medicaid beneficiaries with schizophrenia. Mean age was 47.6 years; 62.1% were male and 58.9% were white non-Hispanic. Of these, 1,079,576 (79.8%) were prescribed an antipsychotic, 72.4% were prescribed an atypical antipsychotic, and 10.7% were prescribed >1 atypical antipsychotic. 41.2% had received psychotherapy, 48.4% had received mental health counseling, and 20.1% both. Among those prescribed an antipsychotic, 51.4% received psychotherapy, 60.4% mental health counseling, and 24.9% both. 85.5% of patients had been seen by a psychiatrist. Comorbid illnesses included depression (45.9%), hypertension (29.4%), obesity (7.3%), hyperlipidemia (6.7%), and diabetes mellitus (6.4%).
Conclusion: Nearly 80% of US Medicaid beneficiaries diagnosed with schizophrenia had received antipsychotics, with over 40% receiving either psychotherapy or mental health counseling, and about half receiving both antipsychotics and psychotherapy. Approximately 10% were prescribed >1 atypical antipsychotic. Future research investigating the impact of interventions on outcomes, predictors of receipt of interventions, and whether utilization is appropriate and equitable is warranted.