How to Provide Medical Care to Psychiatrically Ill Patients at Metabolic Risk

Summary and Comment |
September 16, 2016

How to Provide Medical Care to Psychiatrically Ill Patients at Metabolic Risk

  1. Joel Yager, MD

A behavioral-health home located inside a community health center provided better medical services, but medical outcomes were equivalent to those with usual care.

  1. Joel Yager, MD

Given the high rates of medical comorbidity, particularly cardiometabolic problems, among patients with serious psychiatric disorders, policymakers have asked whether these patients might achieve better health and receive higher-quality general medical care through integrated behavioral-health homes than via current practices. This first-of-its-kind, single-site study enrolled 447 patients with major psychiatric disorders and at least one cardiometabolic risk factor who were seen at a community mental-health center or referred by community providers.

Participants were randomized to receive care at an integrated behavioral-health home or usual care for 12 months. The integrated health home, staffed by a prescribing nurse and a nurse manager fostering healthy lifestyles and backed by a medical director, was physically located at the community mental-health center. Usual-care patients received copies of their lab test results, encouragement to seek medical care, and lists of nearby affordable providers.

In intent-to-treat analyses at 12 months, patients in the health home received higher-quality care (more indicated services, more USPSTF-recommended preventive services, and more care appropriate to chronic illness) and reported better mental quality of life than usual-care patients. On the whole, however, health outcomes (measures related to blood pressure, lipids, and diabetes), many of which improved in both arms, were indistinguishable between groups.

Comment

Although larger studies and longer observation periods might demonstrate advantages for medical homes, the benefits after 12 months were modest at best. The researchers did not compare treatment costs for the two arms. Possibly, providing usual-care patients with lab values, resource lists, and encouragement to seek care resulted in their receiving better care than usual.

Editor Disclosures at Time of Publication

  • Disclosures for Joel Yager, MD at time of publication Editorial boards Bulletin of the Menninger Clinic; Eating Disorders Review (Editor-in-Chief Emeritus); International Journal of Eating Disorders; UpToDate; FOCUS: The Journal of Lifelong Learning in Psychiatry

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