Variation in benefit among patients with serious mental illness who receive integrated psychiatric and primary care

by Alexander S. Young, Jessica Skela, Evelyn T. Chang, Rebecca Oberman, Prabha Siddarth

Purpose

The population with serious mental illness has high risk for hospitalization or death due to unhealthy behaviors and inadequate medical care, though the level of risk varies substantially. Programs that integrate medical and psychiatric services improve outcomes but are challenging to implement and access is limited. It would be useful to know whether benefits are confined to patients with specific levels of risk.

Methods

In a population with serious mental illness and increased risk for hospitalization or death, a specialized medical home integrated services and improved treatment and outcomes. Treatment quality, chronic illness care, care experience, symptoms, and quality of life were assessed for a median of 385 days. Analyses examine whether improvements varied by baseline level of patient risk.

Results

Patients with greater risk were more likely to be older, more cognitively impaired, and have worse mental health. Integrated services increased appropriate screening for body mass index, lipids, and glucose, but increases did not differ significantly by level of risk. Integrated services also improved chronic illness care, care experience, mental health-related quality of life, and psychotic symptoms. There were also no significant differences by risk level.

Conclusions

There were benefits from integration of primary care and psychiatric care at all levels of increased risk, including those with extremely high risk above the 95^th percentile. When developing integrated care programs, patients should be considered at all levels of risk, not only those who are the healthiest.