Racial Differences in the Treatment of Veterans with Bipolar Disorder

Published In: Psychiatric Services, v. 56, no. 12, Dec. 2005, p. 1549-1555

Posted on RAND.org on December 31, 2004

by Amy Kilbourne, Mark S. Bauer, Xiaoyan Han, Gretchen L. Haas, Patrick Elder, Chester B. Good, Mujeeb Shad, Joseph Conigliaro, Harold Alan Pincus

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OBJECTIVES: The authors examined whether African Americans, compared with whites, received guideline-concordant care for bipolar I disorder. METHODS: A retrospective analysis was conducted of data for patients who received a diagnosis of bipolar I disorder in fiscal year 2001 and received care in facilities in the Department of Veterans Affairs (VA) mid-Atlantic region. Indicators of guideline-concordant care were based on prescription data and data on utilization of inpatient and outpatient services from VA databases. RESULTS: A total of 2,316 patients with a diagnosis of bipolar I disorder were identified. Their mean age was 52 years; 9.4 percent (N=218) were women, and 13.1 percent (N=303) were African American. Overall, mood stabilizers were prescribed for 74.6 percent (N=1,728) of the patients; 67.1 percent (N=1,554) had an outpatient mental health visit within 90 days after the index diagnosis, and 54.3 percent (N=1,258) had an outpatient visit within 30 days after discharge from a psychiatric hospitalization. Multivariate logistic regression analyses with adjustment for sociodemographic and facility factors revealed that African Americans were less likely than whites to have an outpatient follow-up visit within 90 days after the index diagnosis. Race was not associated with receipt of mood stabilizers or use of outpatient services after a hospital discharge. CONCLUSIONS: Although a majority of patients received guideline-concordant care for bipolar disorder, potential gaps in continuity of outpatient care may exist for African-American patients.

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