Study Shows Specialized Primary Care Homes are Effective in Treatment of Patients with Serious Mental Illness
BACKGROUND:
People with serious mental illness (SMI), such as schizophrenia or bipolar disorder, have much worse health outcomes than the general population. They have high rates of hospitalization and emergency service use, but low rates of primary care. Primary care clinicians usually have limited training in treating SMI, and mental health-related stigma is prevalent. This project studied the implementation and effectiveness of a primary care medical home specifically designed to improve the healthcare of Veterans with serious mental illness. SMI PACTs (Patient Aligned Care Teams) include a specialized, integrated team that can provide both primary and psychiatric care. They apply VA principles of primary care mental health integration and PACT to SMI. One VA medical center (VAMC) was assigned to the SMI PACT intervention and two VAMCs were assigned to continue with usual care (standard VA PACT care). Between May 2016 and February 2018, 331 Veterans with SMI were recruited (164 received the intervention, and 167 received usual care), and 39 clinicians and managers participated in the study. Patient interviews and administrative data at baseline and one year measured chronic illness care, care experience, preventive screenings, quality of care, symptoms, and quality of life.
FINDINGS:
- A primary care medical home for Veterans with SMI can be safe and more effective than usual care, as well as feasible to implement.
- Compared with Veterans who received usual care, those who received the SMI PACT intervention had greater improvement in screenings, treatment quality, chronic illness care (e.g., goal setting, counseling), care experience (e.g., doctor-patient interaction, care coordination, access), psychotic symptoms, and mental health-related quality of life at 12 months.
- Investigators saw no signs of worsening of mental health status under the SMI PACT model of care.
IMPLICATIONS:
- This care model can be effective and should be considered among the interventions for improving medical care in patient populations with serious mental illness.
LIMITATIONS:
- This study excluded patients who were hospitalized in the last six months, not housed, or treated by other PACTs. While there is a high prevalence of SMI among currently homeless and hospitalized patients, these are patients for whom other established care models are believed to be appropriate.
- Veterans enrolled at the intervention sites had characteristics associated with more severe psychiatric illness. This would be expected to make improving medical care more challenging, so these results may be conservative estimates.
AUTHOR/FUNDING INFORMATION:
This study was partly funded by VA/HSR&D’s Quality Enhancement Research Initiative (QUERI: SDP 12-177). Drs. Young and Chang are part of HSR&D’s Center for Healthcare Innovation, Implementation and Policy (CSHIIP) in Los Angeles, CA.
Young AS, Chang ET, Cohen AN, et al. The Effectiveness of a Specialized Primary Care Medical Home for Patients with Serious Mental Illness. Journal of General Internal Medicine. April 5, 2022; online ahead of print.
