• Primary care medical home found to be mo

    From ScienceDaily@1:317/3 to All on Wed Apr 6 22:30:42 2022
    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.


    ==========================================================================
    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.



    ==========================================================================
    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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