TY - JOUR
KW - Adolescent
KW - Adult
KW - Community Mental Health Services
KW - Female
KW - Health Status
KW - Humans
KW - Male
KW - Mental Disorders/complications/mortality/therapy
KW - Metabolic Syndrome X/therapy
KW - Middle Aged
KW - Patient Care Management
KW - Primary Health Care
KW - Quality of Life
KW - Treatment Outcome
KW - Young Adult
AU - B. G. Druss
AU - S. A. von Esenwein
AU - M. T. Compton
AU - K. J. Rask
AU - L. Zhao
AU - R. M. Parker
A1 - 
AB - OBJECTIVE: Poor quality of healthcare contributes to impaired health and excess mortality in individuals with severe mental disorders. The authors tested a population-based medical care management intervention designed to improve primary medical care in community mental health settings. METHOD: 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. RESULTS: 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%). CONCLUSIONS: 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.
BT - The American Journal of Psychiatry
C5 - General Literature
CP - 2
CY - United States
DO - 10.1176/appi.ajp.2009.09050691
IS - 2
JF - The American Journal of Psychiatry
N2 - OBJECTIVE: Poor quality of healthcare contributes to impaired health and excess mortality in individuals with severe mental disorders. The authors tested a population-based medical care management intervention designed to improve primary medical care in community mental health settings. METHOD: 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. RESULTS: 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%). CONCLUSIONS: 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.
PP - United States
PY - 2010
SN - 1535-7228; 0002-953X
SP - 151
EP - 159
EP - 
T1 - A randomized trial of medical care management for community mental health settings: the Primary Care Access, Referral, and Evaluation (PCARE) study
T2 - The American Journal of Psychiatry
TI - A randomized trial of medical care management for community mental health settings: the Primary Care Access, Referral, and Evaluation (PCARE) study
U1 - General Literature
U2 - 20008945
U3 - 10.1176/appi.ajp.2009.09050691
VL - 167
VO - 1535-7228; 0002-953X
Y1 - 2010
ER -