Family Practice Enhancements for Patients with Severe Mental Illness

Individuals with severe mental health disorders experience difficulty maneuvering the complexity encountered in primary care (PC). This study describes the impact of three components of primary care practice enhancements on: changes in missed appointments, changes in health outcomes, number of ER visits and hospitalization days, and perceptions of integrated care. Missed PC appointments: baseline to post practice enhancement changed from 42 to 11, statistically significant (p < .01). Changes in health outcomes: SF-12 scores had no significant change nor did ER utilization and hospitalization; however, outcomes are low-base rate and assessment period was short. Integration of care: liaison was most helpful in accessing and navigating PC, educating and reconciling medication lists. Behavioral health staff voiced relief regarding access and felt better informed. Strategies focusing on increasing communication, staff education, and reducing barriers to access and receipt of PC may improve integration and continuity of care.

[1]  L. Iezzoni,et al.  Primary care experiences of people with psychiatric disabilities: barriers to care and potential solutions. , 2005, Psychiatric rehabilitation journal.

[2]  J. Santiago,et al.  Health care utilization by persons with severe and persistent mental illness. , 1999, Psychiatric services.

[3]  Timothy J. Servoss,et al.  Primary Care After Psychiatric Crisis: A Qualitative Analysis , 2008, The Annals of Family Medicine.

[4]  A. Green,et al.  Detection and management of comorbidity in patients with schizophrenia. , 2003, The Psychiatric clinics of North America.

[5]  L. Goldman Medical illness in patients with schizophrenia. , 1999, The Journal of clinical psychiatry.

[6]  I. Nazareth,et al.  Prevention of coronary heart disease in people with severe mental illnesses: a qualitative study of patient and professionals' preferences for care , 2006, BMC psychiatry.

[7]  T. Denko,et al.  Active Medical Conditions Among Patients on an Assertive Community Treatment Team , 2006, Community Mental Health Journal.

[8]  B. Druss,et al.  A randomized trial of medical care management for community mental health settings: the Primary Care Access, Referral, and Evaluation (PCARE) study. , 2010, The American journal of psychiatry.

[9]  N. Powe,et al.  Characteristics of primary care visits for individuals with severe mental illness in a national sample. , 2002, General hospital psychiatry.

[10]  F. Dickerson,et al.  Health status of individuals with serious mental illness. , 2005, Schizophrenia bulletin.

[11]  B. Barraclough,et al.  Causes of the excess mortality of schizophrenia. , 2000, The British journal of psychiatry : the journal of mental science.

[12]  A. Wheeler,et al.  Cardiovascular Risk Assessment and Management in Mental Health Clients: Whose Role is it Anyway? , 2010, Community Mental Health Journal.

[13]  H. Lester Current Issues in Providing Primary Medical Care to People with Serious Mental Illness , 2006, International journal of psychiatry in medicine.

[14]  I. Finlay,et al.  Pragmatic randomised trial to evaluate the use of patient held records for the continuing care of patients with cancer , 2001 .

[15]  Martha Sajatovic,et al.  Strategies for Addressing Adherence Problems in Patients with Serious and Persistent Mental Illness: Recommendations From the Expert Consensus Guidelines , 2010, Journal of psychiatric practice.

[16]  M. Davidson Risk of cardiovascular disease and sudden death in schizophrenia. , 2002, The Journal of clinical psychiatry.

[17]  I. Nazareth,et al.  Risk for coronary heart disease in people with severe mental illness , 2006, British Journal of Psychiatry.

[18]  L. Smeeth,et al.  Pragmatic randomised trials using routine electronic health records: putting them to the test , 2012, BMJ : British Medical Journal.

[19]  R. Woolson,et al.  Medical comorbidity in women and men with schizophrenia , 2006, Journal of General Internal Medicine.

[20]  D. Schlundt,et al.  Validity of the SF-12 for Use in a Low-Income African American Community-Based Research Initiative (REACH 2010) , 2008, Preventing chronic disease.

[21]  Michelle P. Salyers,et al.  Reliability and Validity of the SF-12 Health Survey Among People With Severe Mental Illness , 2000, Medical care.

[22]  I. Finlay,et al.  Pragmatic randomised trial to evaluate the use of patient held records for the continuing care of patients with cancer , 2001, Quality in health care : QHC.

[23]  C. Carney,et al.  Medical Comorbidity in Women and Men With Bipolar Disorders: A Population-Based Controlled Study , 2006, Psychosomatic medicine.

[24]  M. Decoux ACUTE VERSUS PRIMARY CARE: THE HEALTH CARE DECISION MAKING PROCESS FOR INDIVIDUALS WITH SEVERE MENTAL ILLNESS , 2005, Issues in mental health nursing.