TY - JOUR
KW - Adolescent
KW - Adult
KW - Age Distribution
KW - Child
KW - Chronic Disease/epidemiology/therapy
KW - Community Mental Health Centers/utilization
KW - Comorbidity
KW - Female
KW - Health Services Accessibility/statistics & numerical data
KW - Humans
KW - Male
KW - Medicaid/statistics & numerical data
KW - Mental Disorders/epidemiology/therapy
KW - Middle Aged
KW - North Carolina/epidemiology
KW - Patient Acceptance of Health Care/statistics & numerical data
KW - Referral and Consultation/statistics & numerical data
KW - Severity of Illness Index
KW - Socioeconomic Factors
KW - United States
KW - Young Adult
AU - J. C. Lichstein
AU - M. E. Domino
AU - C. A. Beadles
AU - A. R. Ellis
AU - J. F. Farley
AU - J. P. Morrissey
AU - G. W. Gauchat
AU - C. A. Dubard
AU - C. T. Jackson
A1 - 
AB - BACKGROUND: Patients with comorbid severe mental illness (SMI) may use primary care medical homes differently than other patients with multiple chronic conditions (MCC). OBJECTIVE: To compare medical home use among patients with comorbid SMI to use among those with only chronic physical comorbidities. RESEARCH DESIGN: We examined data on children and adults with MCC for fiscal years 2008-2010, using generalized estimating equations to assess associations between SMI (major depressive disorder or psychosis) and medical home use. SUBJECTS: Medicaid and medical home enrolled children (age, 6-17 y) and adults (age, 18-64 y) in North Carolina with >/=2 of the following chronic health conditions: major depressive disorder, psychosis, hypertension, diabetes, hyperlipidemia, seizure disorder, asthma, and chronic obstructive pulmonary disease. MEASURES: We examined annual medical home participation (>/=1 visit to the medical home) among enrollees and utilization (number of medical home visits) among participants. RESULTS: Compared with patients without depression or psychosis, children and adults with psychosis had lower rates of medical home participation (-12.2 and -8.2 percentage points, respectively, P0.05). CONCLUSIONS: Overall, medical home use was relatively high for Medicaid enrollees with MCC, though it was somewhat lower among those with SMI. Targeted strategies may be required to increase medical home participation and utilization among SMI patients.
BT - Medical care
C5 - Healthcare Disparities; Medical Home
CY - United States
DO - 10.1097/MLR.0000000000000025
JF - Medical care
N2 - BACKGROUND: Patients with comorbid severe mental illness (SMI) may use primary care medical homes differently than other patients with multiple chronic conditions (MCC). OBJECTIVE: To compare medical home use among patients with comorbid SMI to use among those with only chronic physical comorbidities. RESEARCH DESIGN: We examined data on children and adults with MCC for fiscal years 2008-2010, using generalized estimating equations to assess associations between SMI (major depressive disorder or psychosis) and medical home use. SUBJECTS: Medicaid and medical home enrolled children (age, 6-17 y) and adults (age, 18-64 y) in North Carolina with >/=2 of the following chronic health conditions: major depressive disorder, psychosis, hypertension, diabetes, hyperlipidemia, seizure disorder, asthma, and chronic obstructive pulmonary disease. MEASURES: We examined annual medical home participation (>/=1 visit to the medical home) among enrollees and utilization (number of medical home visits) among participants. RESULTS: Compared with patients without depression or psychosis, children and adults with psychosis had lower rates of medical home participation (-12.2 and -8.2 percentage points, respectively, P0.05). CONCLUSIONS: Overall, medical home use was relatively high for Medicaid enrollees with MCC, though it was somewhat lower among those with SMI. Targeted strategies may be required to increase medical home participation and utilization among SMI patients.
PP - United States
PY - 2014
SN - 1537-1948; 0025-7079
EP - 91
EP - S85+
T1 - Use of medical homes by patients with comorbid physical and severe mental illness
T2 - Medical care
TI - Use of medical homes by patients with comorbid physical and severe mental illness
U1 - Healthcare Disparities; Medical Home
U2 - 24561764
U3 - 10.1097/MLR.0000000000000025
VL - 52 Suppl 3
VO - 1537-1948; 0025-7079
Y1 - 2014
ER -