Psychiatrist Focuses on Populations in Health Delivery Services

At Emory, Druss’s research has been a mix of mining large datasets for information about health-service utilization patterns and intervention studies focused around the issue of improving physical health and health status in people with serious mental illness.

An example of the latter is the PCARE (Primary Care Access, Referral, and Evaluation) model, which employs a medical nurse/care manager to provide education and care coordination to help patients with serious and persistent mental illness engage in primary care.

In a study published in the American Journal of Psychiatry, care managers provided communication and advocacy with medical providers, health education, and support services in overcoming system-level fragmentation and barriers to primary medical care. At a 12-month follow-up evaluation, the intervention group received an average of 58.7 percent of recommended preventive services compared with a rate of 21.8 percent in the usual-care group. They also received a significantly higher proportion of evidence-based services for cardiometabolic conditions and were more likely to have a primary care provider.

“Several features of the PCARE study management model make it an appealing approach for community mental health clinics seeking to improve their patients’ medical care,” Druss and colleagues wrote. “Compared with co-located approaches, care management is relatively inexpensive to implement and practical for even relatively small sites that do not have the financial or staffing resources to establish fully functioning medical clinics on site. Existing mental health care managers can be retrained to add medical services to their scope of activities. Finally, a rationale for CMHCs to address primary care services among their clients may be provided by the fact that improving medical care might be associated with better mental health outcomes.”

Another ongoing project is the HOME (Health Outcome Management Evaluation) Study, which involves a partnership between a federally qualified health center in Atlanta and a local community mental health center (CMHC). The health center has set up a satellite clinic in the CMHC and employs team-based care for patients with serious mental illness and one or more active cardiometabolic problems (such as diabetes, hypertension, and hyperlipidemia). The study uses standardized, validated instruments to assess the impact of integrated community care on quality and outcomes of cardiometabolic and general medical care.

Such projects may seem visionary, but Druss echoes other leaders in the integrated/collaborative care movement in urging individual psychiatrists to reach out to their own hospitals and health systems to offer their unique expertise in the care of patients across the medical spectrum.

“One of the clear lessons that came out of work in this area is that policymakers and administrators trust their own data,” Druss said. “They are not particularly interested in whether something works in some abstract sense or in a randomized, controlled trial done someplace else. What they are most interested in is looking at their own data and understanding which ones are the high-cost patients—and those are invariably patients with comorbid mental conditions.”

And what does the future look like? “One broad theme of what is going on now and is likely to continue is the move to population-based care delivery,” Druss told Psychiatric News. “That’s the common thread through medical homes, accountable care organizations, and other movements today. They are all about improving care across populations.” ■