TY - JOUR
KW - Ambulatory Care Facilities/economics/utilization
KW - assertive community treatment
KW - Community Mental Health Centers/economics/utilization
KW - Community Mental Health Services/economics/utilization
KW - Cooperative Behavior
KW - Cost Savings
KW - Delivery of Health Care, Integrated/economics/organization & administration/utilization
KW - Health Expenditures/statistics & numerical data
KW - Humans
KW - Interdisciplinary Communication
KW - Mental Disorders/economics/nursing
KW - North Carolina
KW - outpatient care
KW - Patient Care Team/economics/utilization
KW - primary care
KW - Primary Health Care/economics/utilization
KW - Utilization Review
AU - E. Wiley-Exley
AU - M. E. Domino
AU - T. C. Ricketts
AU - G. Cuddeback
AU - B. J. Burns
AU - J. Morrissey
A1 - 
AB - BACKGROUND: A number of states have implemented Assertive Community Treatment (ACT) teams statewide. The extent to which team-based care in ACT programs substitutes or complements primary care and other types of health services is relatively unknown outside of clinical trials. OBJECTIVE: To analyze whether investments in ACT yield savings in primary care and other outpatient health services. DESIGN: Patterns of medical and mental health service use and costs were examined using Medicaid claims files from 2000 to 2002 in North Carolina. Two-part models and negative binomial models compared individuals on ACT (n = 1,065 distinct individuals) with two control groups of Medicaid enrollees with severe mental illness not receiving ACT services (n = 1,426 and n = 41,717 distinct individuals). RESULTS: We found no evidence that ACT affected utilization of other outpatient health services or primary care; however, ACT was associated with a decrease in other outpatient health expenditures (excluding ACT) through a reduction in the intensity with which these services were used. Consistent with prior literature, ACT also decreased the likelihood of emergency room visits and inpatient psychiatric stays. CONCLUSIONS: Given the increasing emphasis and efforts toward integrating physical health and behavioral health care, it is likely that ACT will continue to be challenged to meet the physical health needs of its consumers. To improve primary care receipt, this may mean a departure from traditional staffing patterns (e.g., the addition of a primary care doctor and nurse) and expansion of the direct services ACT provides to incorporate physical health treatments.
BT - Journal of the American Psychiatric Nurses Association
C5 - Education & Workforce; Financing & Sustainability
CP - 4
CY - United States
DO - 10.1177/1078390313494170
IS - 4
JF - Journal of the American Psychiatric Nurses Association
N2 - BACKGROUND: A number of states have implemented Assertive Community Treatment (ACT) teams statewide. The extent to which team-based care in ACT programs substitutes or complements primary care and other types of health services is relatively unknown outside of clinical trials. OBJECTIVE: To analyze whether investments in ACT yield savings in primary care and other outpatient health services. DESIGN: Patterns of medical and mental health service use and costs were examined using Medicaid claims files from 2000 to 2002 in North Carolina. Two-part models and negative binomial models compared individuals on ACT (n = 1,065 distinct individuals) with two control groups of Medicaid enrollees with severe mental illness not receiving ACT services (n = 1,426 and n = 41,717 distinct individuals). RESULTS: We found no evidence that ACT affected utilization of other outpatient health services or primary care; however, ACT was associated with a decrease in other outpatient health expenditures (excluding ACT) through a reduction in the intensity with which these services were used. Consistent with prior literature, ACT also decreased the likelihood of emergency room visits and inpatient psychiatric stays. CONCLUSIONS: Given the increasing emphasis and efforts toward integrating physical health and behavioral health care, it is likely that ACT will continue to be challenged to meet the physical health needs of its consumers. To improve primary care receipt, this may mean a departure from traditional staffing patterns (e.g., the addition of a primary care doctor and nurse) and expansion of the direct services ACT provides to incorporate physical health treatments.
PP - United States
PY - 2013
SN - 1532-5725; 1078-3903
SP - 195
EP - 204
EP - 
T1 - The impact of Assertive Community Treatment on utilization of primary care and other outpatient health services: the North Carolina experience
T2 - Journal of the American Psychiatric Nurses Association
TI - The impact of Assertive Community Treatment on utilization of primary care and other outpatient health services: the North Carolina experience
U1 - Education & Workforce; Financing & Sustainability
U2 - 23824135
U3 - 10.1177/1078390313494170
VL - 19
VO - 1532-5725; 1078-3903
Y1 - 2013
ER -