Grant number: 1K23MH126078
Grant period: 4/1/2022 – 3/31/2027
Brief narrative: People with severe mental illness (SMI) face double the risk for type 2 diabetes compared to the general population, contributing to higher rates of cardiovascular disease and premature death. Common use of antipsychotic medications contributes to these health risks due to prevalent metabolic side effects. Many younger adults with SMI do not receive targeted, evidence-based cardiometabolic disease prevention care. Underused strategies include: prescribing alternative, less obesogenic psychotropic medications; lifestyle change supports; additional risk-reducing medications; and smoking cessation therapies. Our preliminary qualitative data with patients and clinicians identified a need for tools to match prevention care to individuals’ risk level and preferences, and tools suited to population-based care strategies. Clinical Decision Support (CDS) tools are computer algorithms that use patients’ data, predictive analytics, and clinical guidelines to promote evidence-based care by helping patients and clinicians navigate complex treatment decisions. Through this mentored K23 career development award, Esti Iturralde, PhD will build upon her background as a clinical psychologist and behavioral diabetes researcher. Through planned mentoring, coursework, and career development activities, Dr. Iturralde will gain a strong understanding of psychopharmacology and cardiometabolic health, advanced predictive analytics, and implementation science, including methods for stakeholder-engaged intervention design and pragmatic clinical trials. As a researcher in the Kaiser Permanente Northern California (KPNC) Division of Research (DOR), she will leverage robust, longitudinal electronic health record (EHR) data (> 50,000 adults from diverse racial/ethnic groups) and stakeholder insights (patients, clinicians, and health system decision-makers) within health systems including KPNC and 2 others belonging to the NIMH-funded Mental Health Research Network (HealthPartners Institute and Henry Ford Health System). The proposed research will support the training goals while contributing to the development of a novel CDS tool seeking to increase targeted, evidence-based diabetes and cardiovascular disease prevention care for adults under age 45 who are starting antipsychotic medications. Specific research aims are to: (1) inform predictive analytics of the CDS tool by developing and validating diabetes risk prediction models for the target population; (2) engage stakeholders in the design of CDS tool messaging and implementation pathways; and field-test CDS tool messaging through a pragmatic clinical trial conducted within an existing KPNC telehealth-based population management program serving this population. A future R01 application will build on the results from this project to further refine and test the CDS tool within multiple health systems. The linked research and training aims will directly prepare Dr. Iturralde for success as an embedded health system researcher and prepare her to lead a programmatic line of studies developing and implementing data-driven, feasible, scalable interventions improving the cardiometabolic health of people with SMI.
Lead site: KPNC (PI Esti Iturralde)
Summary of Findings
Funder: NIMH (MHRN III Feasibility Pilot Program)
Grant Number: U19MH121738
Project Period: 7/1/2021 – 6/30/2022
Background: Psychiatric disorders, and especially severe mental illness (SMI), are associated with an increased risk of COVID-19 infection and COVID-19-related morbidity and mortality. Several studies have found an association between an existing psychiatric disorder and increased risk for COVID-19 infection and COVID-19-related hospitalization, morbidity, and mortality. Factors that contribute to worse outcomes include concomitant medications, poorer premorbid general health, physical comorbidity, reduced access to medical care, and environmental and lifestyle factors such as lower socioeconomic status, smoking, or obesity. In light of these vulnerabilities, it is important that people with SMI receive a vaccination. However, people with SMI are less likely to receive preventive or guideline-appropriate health care for concerns such as cardiovascular disease and cancer. This reduced access to preventive care is reflected in the low uptake of immunizations recommended for adults among people with SMI. Of these, influenza may serve as a particularly useful model given the recommendation for an annual vaccination. In contrast with other vulnerable groups in the United States, influenza vaccination rates among people with SMI are as low as 25%. The purpose of this analysis is to examine COVID-19 vaccine uptake among individuals with diagnosed psychiatric disorders compared to individuals without any diagnosed psychiatric disorders and to examine whether there is variation by type of diagnosis, sociodemographic and/or clinical characteristics. There have been no known studies published to date that address this topic.
- Research Questions:
- Are individuals with diagnosed psychiatric disorders more or less likely to have received the COVID vaccine compared to those without any diagnosed psychiatric disorders? How does this pattern compare to uptake of the flu vaccine in this population?
- Among those with diagnosed psychiatric disorders, is there variation in COVID vaccination status by type of psychiatric disorder? By other sociodemographic and clinical characteristics?
Methods: Using electronic medical record data across 2 Mental Health Research Network sites (KPGA and KPSC), individuals with diagnosed psychiatric disorders will be identified and matched on age and sex to controls with no diagnosed psychiatric disorders.
- Compare sample characteristics of persons with and without any psychiatric disorder using χ2 tests for categorical variables and t tests for continuous variables.
- Calculate the proportion of eligible patients who received the COVID-19 vaccine by psychiatric status (no diagnosis vs. psychiatric diagnosis).
- Use multivariable methods to examine the relationship between psychiatric disorders status and vaccine uptake, controlling for demographic characteristics, medical comorbidities (Charlson score), and whether individual lives in rural or medically-underserved area.
Planned Product: The results of this study will be published and presented at a conference and will be used as preliminary data to guide (1) qualitative research to better understand any differences between patients with vs. without mental health conditions and/or (2) intervention research to improve vaccine uptake in this population.
- Lead Site: KPGA (PI Ashli Owen-Smith)
- Participating Sites:
- KPSC (Co-I Karen Coleman)
- KPWA (Lead Analyst Chris Stewart)
Manuscript is in-progress (will be ready to submit for publication by end of the year)
Summary of Findings: