Primary care medical home found to be more effective than usual care in treating patients with serious mental illness

Date:
April 6, 2022
Source:
University of California - Los Angeles Health Sciences
Summary:
A new study has shown that a specialized primary care medical home
improved the care and treatment of patients with serious mental
illness, resulting in better mental health-related quality of life.



FULL STORY ==========================================================================
A new study led by researchers at UCLA has shown that a specialized
primary care medical home improved the care and treatment of patients
with serious mental illness, resulting in better mental health-related
quality of life.


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The study, published April 5 in the Journal of General Internal Medicine,
is the first controlled trial to look at the benefits of a primary care
medical home for patients with serious mental illnesses (SMI), such as schizophrenia or bipolar disorder, who die at rates three times higher
than the general population.

Individuals with serious mental illnesses often have psychiatric symptoms, cognitive deficits, impaired social skills, social disadvantage and high
rates of addiction to substances, including tobacco. These individuals
use hospitals and emergency rooms more frequently than patients with
chronic illnesses alone -- but use primary care less often and are less
likely to receive high value preventative and chronic care services.

The patient-centered medical home is a care model that provides
comprehensive, coordinated care among patients and their clinicians
through the use of registries, information technology and other
resources. It is intended to ensure that patients receive care on
a continuous basis to better manage chronic conditions and maintain
wellness -- rather than just during separate, periodic visits to the
doctor's office.

"Just as few psychiatrists are trained in primary care or can provide
these services, the same is true for primary care physicians and we need
to be able to better coordinate care for these vulnerable patients,"
said Dr. Alex Young, lead author of the study and interim chair of
the department of psychiatry and director of the Semel Institute for Neuroscience & Human Behavior at the David Geffen School of Medicine at
UCLA, and associate director of the Health Services Unit at the VA VISN 22 Mental Illness, Research, Education and Clinical Center. "Our team's study shows that a patient-centered medical home can be effective and should
be considered for improving the health care of patients with serious
mental illnesses." Numerous efforts to improve care for patients with
SMI and to reduce the use of high-cost emergency visits have involved a
variety of approaches, including co- locating mental health and primary
care. However, most have failed to produce substantial improvement in
patients' treatment or care outcomes when compared to individuals with
SMI receiving usual services.



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To find out how effective the patient-centered medical home was to
improve care and treatment of patients with SMI, the researchers designed, implemented, and studied a specialized patient-centered medical home in
the U.S. Veterans Health (VA) Administration, referred to by the VA as
Patient Aligned Care Teams or PACTs.

Three VA medical centers participated in the study: VA Greater Los
Angeles, VA San Diego and VA Southern Nevada Healthcare Systems, with
one location assigned to implement the intervention, and the other
two serving as a comparison group receiving the usual care provided to
patients with SMI. Patients with seriously mental illness were those
with schizophrenia, bipolar disorder, recurrent major depression with
psychosis or chronic severe post-traumatic stress disorder.

Care in the "intervention group" was provided by a specialized,
integrated team of healthcare professionals that provided both primary
and psychiatric care, including a primary care doctor and a nurse care
manager who were co-located at the same site. A psychiatrist consulted
to the team, including being available by phone, instant messaging or
email. All patients were given the choice to continue receiving mental
health care from their established psychiatrist elsewhere or to move
all their psychiatric care to the SMI PACT medical home team.

In the "usual" care group, patients continued to receive care as usual,
with primary care delivered by a team of a clinicians -- either a
physician or nurse practitioner -- a nurse, medical assistant and
clerks. Services for patients were provided at specialty mental health
clinics that were separate from primary care.

In the study of 331 patients with SMI,164 received the "intervention,"
under the new care model, while 167 received usual care at the other
two VA medical centers. Participants were in the study for an average
of 401 days.

To evaluate the effectiveness of the primary medical home model, the researchers examined data taken from patient surveys at the beginning
of the study and after 12 months that measured primary preventive
screenings, perceived chronic illness care, patients' care experience, and health-related quality of life. Additional outcomes such as psychiatric symptoms and care for chronic illness were also measured along with data
on various screenings, diagnoses, prescriptions, services and medical
visits to determine the appropriateness and quality of treatment.

Key findings from the study showed that 40 percent of intervention
participants moved their psychiatric care to the primary care SMI
PACT. The intervention patients also experienced greater improvement
over time in appropriate screenings that included: body mass index (87.8%
vs. 70.5% receiving usual care), lipids (53.7% vs. 24.7% receiving usual
care); and glucose (72.6% vs.

51.2% receiving usual care). There was also greater improvement in
all areas of chronic illness care such as decision support, goal
setting, and counseling as well as care experience in doctor-patient interactions, shared decision-making, care coordination, access to care
and mental-health related quality of life.

"While people with serious mental illness are some of the most challenging
and expensive patients to treat, it is possible to help seriously mentally
ill individuals be healthy and productive, while minimizing their need
to use hospital and emergency departments," said Dr. Young. "We found
this care model to be effective in improving treatment appropriateness
and patient outcomes.

And while this model certainly needs further study, it should be
considered to improve care for people with serious mental illness."

========================================================================== Story Source: Materials provided by University_of_California_-_Los_Angeles_Health_Sciences.

Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Alexander S. Young, Evelyn T. Chang, Amy N. Cohen, Rebecca Oberman,
Dennis T. Chang, Alison B. Hamilton, Laurie A. Lindamer, Jesse
Sanford, Fiona Whelan. The Effectiveness of a Specialized Primary
Care Medical Home for Patients with Serious Mental Illness. Journal
of General Internal Medicine, 2022; DOI: 10.1007/s11606-021-07270-x ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/04/220406101754.htm

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