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Published Online: 1 February 2010

A Randomized Trial of Medical Care Management for Community Mental Health Settings: The Primary Care Access, Referral, and Evaluation (PCARE) Study

Abstract

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.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 151 - 159
PubMed: 20008945

History

Received: 18 May 2009
Accepted: 6 August 2009
Published online: 1 February 2010
Published in print: February 2010

Authors

Details

Benjamin G. Druss, M.D., M.P.H.
Silke A. von Esenwein, Ph.D.
Michael T. Compton, M.D., M.P.H.
Kimberly J. Rask, M.D., Ph.D.

Notes

Received May 18, 2009; revision received Aug. 5, 2009; accepted Aug. 6, 2009. From the Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta; and the Department of General Internal Medicine, Emory University School of Medicine, Atlanta. Address correspondence and reprint requests to Dr. Druss, Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Rd., NE, Rm. 606, Atlanta, GA 30322; [email protected] (e-mail).

Competing Interests

Dr. Druss has received research funding from Pfizer. Drs. von Esenwein, Compton, Rask, and Parker and Mr. Zhao report no financial relationships with commercial interests.

Funding Information

Supported by NIMH grants R01MH-070437 and K24MH-075867.Clinicaltrials.gov registry number, NCT00183313 (www.clinicaltrials.gov).

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