TY - JOUR
KW - Adult
KW - Analysis of Variance
KW - Comorbidity
KW - Delivery of Health Care, Integrated/methods/organization & administration
KW - Emergency Services, Psychiatric/statistics & numerical data
KW - Female
KW - Health Services Accessibility/statistics & numerical data
KW - Healthcare Disparities
KW - Humans
KW - Interprofessional Relations
KW - Interviews as Topic
KW - Male
KW - Mentally Ill Persons/psychology/statistics & numerical data
KW - Middle Aged
KW - Outcome and Process Assessment (Health Care)
KW - Patient Care Management/utilization
KW - Patient Satisfaction
KW - Primary Health Care/organization & administration/statistics & numerical data
KW - Qualitative Research
AU - K. S. Griswold
AU - L. E. Zayas
AU - P. A. Pastore
AU - S. J. Smith
AU - C. M. Wagner
AU - T. J. Servoss
A1 - 
AB - PURPOSE: Patients with serious psychiatric problems experience difficulty accessing primary care. The goals of this study were to assess whether care managers improved access and to understand patients' experiences with health care after a psychiatric crisis. METHODS: A total of 175 consecutive patients seeking care in a psychiatric emergency department were randomly assigned to an intervention group with care managers or a control group. Brief, semistructured interviews about health care encounters were conducted at baseline and 1 year later. Five raters, using the content-driven, immersion-crystallization approach, analyzed 112 baseline and year-end interviews from 28 participants in each group. The main outcomes were patients' responses about their care experiences, connections with primary care, and integration of medical and mental health care. Scores for physical function and mental function were compared by analysis of variance (ANOVA). RESULTS: At baseline, most participants described negative experiences in receiving care and emphasized the importance of listening, sensitivity, and respect. Fully 71% of patients in the intervention group said that having a care manager to assist them with primary care connections was beneficial. Patients in the intervention group had significantly better physical and mental function than their counterparts in the control group at 6 months (P = .03 for each) but not at 12 months. There was also a trend toward functional improvement over the course of the study in the intervention group. CONCLUSIONS: This analysis suggests that care management is effective in helping patients access primary care after a psychiatric crisis. It provides evidence on and insight into how care may be delivered more effectively for this population. Future work should assess the sustainability of care connections and longer-term patient health outcomes.
BT - Annals of family medicine
C5 - Healthcare Disparities
CP - 1
CY - United States
DO - 10.1370/afm.760
IS - 1
JF - Annals of family medicine
N2 - PURPOSE: Patients with serious psychiatric problems experience difficulty accessing primary care. The goals of this study were to assess whether care managers improved access and to understand patients' experiences with health care after a psychiatric crisis. METHODS: A total of 175 consecutive patients seeking care in a psychiatric emergency department were randomly assigned to an intervention group with care managers or a control group. Brief, semistructured interviews about health care encounters were conducted at baseline and 1 year later. Five raters, using the content-driven, immersion-crystallization approach, analyzed 112 baseline and year-end interviews from 28 participants in each group. The main outcomes were patients' responses about their care experiences, connections with primary care, and integration of medical and mental health care. Scores for physical function and mental function were compared by analysis of variance (ANOVA). RESULTS: At baseline, most participants described negative experiences in receiving care and emphasized the importance of listening, sensitivity, and respect. Fully 71% of patients in the intervention group said that having a care manager to assist them with primary care connections was beneficial. Patients in the intervention group had significantly better physical and mental function than their counterparts in the control group at 6 months (P = .03 for each) but not at 12 months. There was also a trend toward functional improvement over the course of the study in the intervention group. CONCLUSIONS: This analysis suggests that care management is effective in helping patients access primary care after a psychiatric crisis. It provides evidence on and insight into how care may be delivered more effectively for this population. Future work should assess the sustainability of care connections and longer-term patient health outcomes.
PP - United States
PY - 2008
SN - 1544-1717; 1544-1709
SP - 38
EP - 43
EP - 
T1 - Primary care after psychiatric crisis: a qualitative analysis
T2 - Annals of family medicine
TI - Primary care after psychiatric crisis: a qualitative analysis
U1 - Healthcare Disparities
U2 - 18195313
U3 - 10.1370/afm.760
VL - 6
VO - 1544-1717; 1544-1709
Y1 - 2008
ER -