Visit Patterns for Severe Mental Illness with Implementation of Integrated Care: A Pilot Retrospective Cohort Study

Meghan Fondow; Nancy Pandhi; Jason Ricco; Elizabeth Zeidler Schreiter; Lauren Fahey; Neftali Serrano; Marguerite Burns; Elizabeth A. Jacobs; Meghan Fondow; Nancy Pandhi; Jason Ricco; Elizabeth Zeidler Schreiter; Lauren Fahey; Neftali Serrano; Marguerite Burns; Elizabeth A. Jacobs

doi:10.3934/publichealth.2015.4.821

AIMS Public Health

2015, Volume 2, Issue 4: 821-831. doi: 10.3934/publichealth.2015.4.821

Previous Article Next Article

Research article Special Issues

Visit Patterns for Severe Mental Illness with Implementation of Integrated Care: A Pilot Retrospective Cohort Study

1.
Access Community Health Centers;
2.
University of Wisconsin School of Medicine and Public Health;
3.
Health Innovation Program;
4.
Primary care Academics Transforming Healthcare Collaborative;
5.
University of Minnesota

Received: 25 June 2015 Accepted: 09 December 2015 Published: 15 December 2015

There is increasing interest in models that integrate behavioral health services into primary care. For patients with severe mental illness (SMI), a population with disproportionate morbidity and mortality, little is known about the impact of such models on primary care clinic utilization, and provider panels. We performed a retrospective cohort pilot study examining visit patterns for 1,105 patients with SMI overall, by provider, before, and after the implementation of a primary care behavioral health model which had a ramp up period from May 2006-August 2007. We used 2003-2012 electronic health record data from two clinics of a Federally Qualified Health Center and conducted interrupted time series and chi-square analyses. During the intervention period there was a significant increase in the proportion of visits per month to the clinic for patient with SMI relative to overall visits (0.27; 95% CI 0.22-0.32). After the intervention period, this rate declined (-0.23; -0.19-0.28) but remained above the pre-intervention period. After integration of behavioral health into our primary care clinics, there was a sharp increase in the number of patients with SMI, suggesting patient willingness to explore receiving care under this model. Clinics looking to adopt the model should be mindful of potential changes in patient subpopulations and proactively manage this transition.
- primary care behavioral health,
- integrated care,
- severe mental illness,
- primary care,
- visit patterns
Citation: Meghan Fondow, Nancy Pandhi, Jason Ricco, Elizabeth Zeidler Schreiter, Lauren Fahey, Neftali Serrano, Marguerite Burns, Elizabeth A. Jacobs. Visit Patterns for Severe Mental Illness with Implementation of Integrated Care: A Pilot Retrospective Cohort Study[J]. AIMS Public Health, 2015, 2(4): 821-831. doi: 10.3934/publichealth.2015.4.821

Related Papers:

Abstract

There is increasing interest in models that integrate behavioral health services into primary care. For patients with severe mental illness (SMI), a population with disproportionate morbidity and mortality, little is known about the impact of such models on primary care clinic utilization, and provider panels. We performed a retrospective cohort pilot study examining visit patterns for 1,105 patients with SMI overall, by provider, before, and after the implementation of a primary care behavioral health model which had a ramp up period from May 2006-August 2007. We used 2003-2012 electronic health record data from two clinics of a Federally Qualified Health Center and conducted interrupted time series and chi-square analyses. During the intervention period there was a significant increase in the proportion of visits per month to the clinic for patient with SMI relative to overall visits (0.27; 95% CI 0.22-0.32). After the intervention period, this rate declined (-0.23; -0.19-0.28) but remained above the pre-intervention period. After integration of behavioral health into our primary care clinics, there was a sharp increase in the number of patients with SMI, suggesting patient willingness to explore receiving care under this model. Clinics looking to adopt the model should be mindful of potential changes in patient subpopulations and proactively manage this transition.

References

[1]	[ Parks J, Svendsen D, Singer P, et al. (2006) Morbidity and Mortality in People with Serious Mental Illness. Alexandria, VA: National Association of State Mental Health Program Directors Medical Directors Council.
[2]	[ Jones DR, Macias C, Barreira PJ, et al. (2004) Prevalence, severity, and co-occurrence of chronic physical health problems of persons with serious mental illness. Psychiatric Services 55: 1250-1257.
[3]	[ Sokal J, Messias E, Dickerson FB, et al. (2004) Comorbidity of medical illnesses among adults with serious mental illness who are receiving community psychiatric services. J Nervous Mental Disease 192: 421-427.
[4]	[ Cummings NA, O'Donohue W, Hays SC, et al. (2001) Integrated Behavioral Healthcare: Positioning Mental Health Practice with Medical/Surgical Practice. San Diego: Academic Press.
[5]	[ Regier DA, Goldberg ID, Taube CA (1978) The de facto US mental health services system: a public health perspective. Archives Gener Psych 35: 685-693.
[6]	[ Mental Health America (2007) Communicating About Health: A Mental Health America Survey of People with Schizophrenia and Providers. Alexandria, VA: Mental Health America.
[7]	[ Morden NE, Mistler LA, Weeks WB, et al. (2009) Health care for patients with serious mental illness: family medicine's role. J Am Board Family Med 22: 187-195.
[8]	[ Daub S (2014) Turning toward treating the seriously mentally ill in primary care. Fam Syst Health 32: 12-13.
[9]	[ Kisely S, Duerden D, Shaddick S, et al. (2006) Collaboration between primary care and psychiatric services: does it help family physicians? Canadian Family Physician 52: 876-877.
[10]	[ Robinson PJ, Reiter JT (2007) Behavioral Consultation and Primary Care. New York: Springer Science.
[11]	[ Altschuler J, Margolius D, Bodenheimer T, et al. (2012) Estimating a reasonable patient panel size for primary care physicians with team-based task delegation. Annals of Family Med 10: 396-400.
[12]	[ Muldoon L, Dahrouge S, Russell G, et al. (2012) How many patients should a family physician have? Factors to consider in answering a deceptively simple question. Healthcare Policy 7: 26-34.
[13]	[ Martin JL, McLean G, Park J, et al. (2014) Impact of socioeconomic deprivation on rate and cause of death in severe mental illness. BMC psychiatry 14: 261.
[14]	[ Reilly S, Planner C, Gask L, et al. (2013) Collaborative care approaches for people with severe mental illness. The Cochrane database of systematic reviews 11: CD009531.
[15]	[ Morrato EH, Newcomer JW, Kamat S, et al. (2009) Metabolic screening after the American Diabetes Association's consensus statement on antipsychotic drugs and diabetes. Diabetes Care 32: 1037-1042.
[16]	[ Nasrallah HA, Meyer JM, Goff DC, et al. (2006) Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: data from the CATIE schizophrenia trial sample at baseline. Schizophrenia Res 86: 15-22.
[17]	[ Frayne SM, Halanych JH, Miller DR, et al. (2005) Disparities in diabetes care: impact of mental illness. Archives Int Med 165: 2631-2638.
[18]	[ Haupt DW, Rosenblatt LC, Kim E, et al. (2009) Prevalence and predictors of lipid and glucose monitoring in commercially insured patients treated with second-generation antipsychotic agents. Am J Psychiatry 166: 345-353.
[19]	[ Zeidler Schreiter E (2013) Integration of behavioral health team and consulting psychiatrist into primary care enhances access to behavioral health care for low-income patients. Agency for Healthcare Research and Quality Health Care Innovations Exchange.
[20]	[ Zeidler Schreiter E, Pandhi N, Fondow M (2013) Access Community Health Centers (Access) Integrated Primary Care Consulting Psychiatry Toolkit.
[21]	[ Zeidler Schreiter E, Pandhi N, Fondow M, et al. (2013) Consulting psychiatry within an integrated primary care model. J Health Care Poor Underserved 24: 1522-1530.
[22]	[ van Orden ML, Deen ML, Spinhoven P, et al. (2015) Five-Year Mental Health Care Use by Patients Referred to Collaborative Care or to Specialized Care. Psychiatr Serv: appips201400238.

Reader Comments

Your name:*

Email:*
© 2015 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)