TY - JOUR
KW - Humans
KW - Medicaid
KW - Mental Disorders/diagnosis/epidemiology/therapy
KW - North Carolina/epidemiology
KW - Primary Health Care
KW - Retrospective Studies
KW - United States/epidemiology
KW - enhanced primary care
KW - integrated care
KW - Schizophrenia
KW - serious mental illness
AU - L. R. Grove
AU - A. K. Gertner
AU - K. E. Swietek
AU - C. C. Lin
AU - N. Ray
AU - T. L. Malone
AU - D. L. Rosen
AU - T. R. Zarzar
AU - M. E. Domino
AU - B. Sheitman
AU - B. D. Steiner
A1 - 
AB - BACKGROUND: Strategies are needed to better address the physical health needs of people with serious mental illness (SMI). Enhanced primary care for people with SMI has the potential to improve care of people with SMI, but evidence is lacking. OBJECTIVE: To examine the effect of a novel enhanced primary care model for people with SMI on service use and screening. DESIGN: Using North Carolina Medicaid claims data, we performed a retrospective cohort analysis comparing healthcare use and screening receipt of people with SMI newly receiving enhanced primary care to people with SMI newly receiving usual primary care. We used inverse probability of treatment weighting to estimate average differences in outcomes between the treatment and comparison groups adjusting for observed baseline characteristics. PARTICIPANTS: People with SMI newly receiving primary care in North Carolina. INTERVENTIONS: Enhanced primary care that includes features tailored for individuals with SMI. MAIN MEASURES: Outcome measures included outpatient visits, emergency department (ED) visits, inpatient stays and days, and recommended screenings 18 months after the initial primary care visit. KEY RESULTS: Compared to usual primary care, enhanced primary care was associated with an increase of 1.2 primary care visits (95% confidence interval [CI]: 0.31 to 2.1) in the 18 months after the initial visit and decreases of 0.33 non-psychiatric inpatient stays (CI: - 0.49 to - 0.16) and 3.0 non-psychiatric inpatient days (CI: - 5.3 to - 0.60). Enhanced primary care had no significant effect on psychiatric service and ED use. Enhanced primary care increased the probability of glucose and HIV screening, decreased the probability of lipid screening, and had no effect on hemoglobin A1c and colorectal cancer screening. CONCLUSIONS: Enhanced primary care for people with SMI can increase receipt of some preventive screening and decrease use of non-psychiatric inpatient care compared to usual primary care.
AD - Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr., Chapel Hill, NC, 27599-7411, USA. lrgrove@live.unc.edu.; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr., Chapel Hill, NC, 27599-7411, USA.; NORC at the University of Chicago, Boston, USA.; National Taiwan University, Taipei, Taiwan.; Center for Medication Optimization, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, USA.; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr., Chapel Hill, NC, 27599-7411, USA.; Institute for Global Health and Infectious Diseases, Division of Infectious Diseases, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.; Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.; Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr., Chapel Hill, NC, 27599-7411, USA.; Department of Psychiatry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, USA.; North Carolina Department of Public Safety-Prisons, Raleigh, USA.; Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.
BT - Journal of general internal medicine
C5 - Financing & Sustainability; Healthcare Disparities
CP - 4
DO - 10.1007/s11606-020-06429-2
IS - 4
JF - Journal of general internal medicine
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Strategies are needed to better address the physical health needs of people with serious mental illness (SMI). Enhanced primary care for people with SMI has the potential to improve care of people with SMI, but evidence is lacking. OBJECTIVE: To examine the effect of a novel enhanced primary care model for people with SMI on service use and screening. DESIGN: Using North Carolina Medicaid claims data, we performed a retrospective cohort analysis comparing healthcare use and screening receipt of people with SMI newly receiving enhanced primary care to people with SMI newly receiving usual primary care. We used inverse probability of treatment weighting to estimate average differences in outcomes between the treatment and comparison groups adjusting for observed baseline characteristics. PARTICIPANTS: People with SMI newly receiving primary care in North Carolina. INTERVENTIONS: Enhanced primary care that includes features tailored for individuals with SMI. MAIN MEASURES: Outcome measures included outpatient visits, emergency department (ED) visits, inpatient stays and days, and recommended screenings 18 months after the initial primary care visit. KEY RESULTS: Compared to usual primary care, enhanced primary care was associated with an increase of 1.2 primary care visits (95% confidence interval [CI]: 0.31 to 2.1) in the 18 months after the initial visit and decreases of 0.33 non-psychiatric inpatient stays (CI: - 0.49 to - 0.16) and 3.0 non-psychiatric inpatient days (CI: - 5.3 to - 0.60). Enhanced primary care had no significant effect on psychiatric service and ED use. Enhanced primary care increased the probability of glucose and HIV screening, decreased the probability of lipid screening, and had no effect on hemoglobin A1c and colorectal cancer screening. CONCLUSIONS: Enhanced primary care for people with SMI can increase receipt of some preventive screening and decrease use of non-psychiatric inpatient care compared to usual primary care.
PY - 2021
SN - 1525-1497; 0884-8734; 0884-8734
SP - 970
EP - 977
EP - 
T1 - Effect of Enhanced Primary Care for People with Serious Mental Illness on Service Use and Screening
T2 - Journal of general internal medicine
TI - Effect of Enhanced Primary Care for People with Serious Mental Illness on Service Use and Screening
U1 - Financing & Sustainability; Healthcare Disparities
U2 - 33506397
U3 - 10.1007/s11606-020-06429-2
VL - 36
VO - 1525-1497; 0884-8734; 0884-8734
Y1 - 2021
Y2 - Apr
ER -