Medical care management for the severely mentally ill

January 01, 0001

Medical care management for the severely mentally ill

Poor quality of healthcare contributes to impaired health and excess mortality in individuals with severe mental disorders. These US authors tested a population-based medical care management intervention designed to improve primary medical care in community mental health settings. A total of 407 subjects with severe mental illness at an urban community mental health center were randomly assigned to either the medical care management intervention or usual care. For individuals in the intervention group, care managers provided communication and advocacy with medical providers, health education, and support in overcoming system-level fragmentation and barriers to primary medical care.

They found: ‘At a 12-month follow-up evaluation, the intervention group received an average of 58.7% of recommended preventive services compared with a rate of 21.8% in the usual care group. They also received a significantly higher proportion of evidence-based services for cardiometabolic conditions (34.9% versus 27.7%) and were more likely to have a primary care provider (71.2% versus 51.9%). The intervention group showed significant improvement on the SF-36 mental component summary (8.0% versus a 1.1% decline in the usual care group) and a nonsignificant improvement on the SF-36 physical component summary. Among subjects with available laboratory data, scores on the Framingham Cardiovascular Risk Index were significantly better in the intervention group (6.9%) than the usual care group (9.8%)."

The authors concluded: "Medical care management was associated with significant improvements in the quality and outcomes of primary care. These findings suggest that care management is a promising approach for improving medical care for patients treated in community mental health settings."

This population of patients often has significant barriers to medical care beyond their psychiatric condition.

For the full abstract, click here.

Am J Psychiatry 167:151-159, February 2010
© 2010 to American Psychiatric Association
A Randomized Trial of Medical Care Management for Community Mental Health Settings: The Primary Care Access, Referral, and Evaluation (PCARE) Study. Benjamin G. Druss, Silke A. von Esenwein, Michael T. Compton, Kimberly J. Rask, Liping Zhao, and Ruth M. Parker. Correspondence to Dr. Druss: [email protected]

Category: HSR .Health Services Research, P. Psychological. Keywords: community mental health, medical care management, mental illness, cardiometabolic conditions, preventive care, randomized controlled trial, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 9 March 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.