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Integrated Medical Care for Patients With Serious Psychiatric Illness
A Randomized Trial
Benjamin G. Druss, MD, MPH;
Robert M. Rohrbaugh, MD;
Carolyn M. Levinson, MPH;
Robert A. Rosenheck, MD
Arch Gen Psychiatry. 2001;58:861-868.
Background This randomized trial evaluated an integrated model of primary medical
care for a cohort of patients with serious mental disorders.
Methods A total of 120 individuals enrolled in a Veterans Affairs (VA) mental
health clinic were randomized to receive primary medical care through an integrated
care initiative located in the mental health clinic (n = 59) or through the
VA general medicine clinic (n = 61). Veterans who obtained care in the integrated
care clinic received on-site primary care and case management that emphasized
preventive medical care, patient education, and close collaboration with mental
health providers to improve access to and continuity of care. Analyses compared
health process (use of medical services, quality of care, and satisfaction)
and outcomes (health and mental health status and costs) between the groups
in the year after randomization.
Results Patients treated in the integrated care clinic were significantly more
likely to have made a primary care visit and had a greater mean number of
primary care visits than those in the usual care group. They were more likely
to have received 15 of the 17 preventive measures outlined in clinical practice
guidelines. Patients assigned to the integrated care clinic had a significantly
greater improvement in health as measured by the physical component summary
score of the 36-Item Short-Form Health Survey than patients assigned to the
general medicine clinic (4.7 points vs -0.3 points, P<.001). There were no significant differences between the 2 groups
in any of the measures of mental health symptoms or in total health care costs.
Conclusion On-site, integrated primary care was associated with improved quality
and outcomes of medical care.
From the Departments of Psychiatry (Drs Druss, Rohrbaugh, and Rosenheck
and Ms Levinson) and Public Health (Drs Druss and Rosenheck), Yale University,
and Northeast Program Evaluation Center, VA Healthcare System (Ms Levinson),
West Haven, Conn.
Corresponding author and reprints: Benjamin G. Druss, MD, MPH, 950
Campbell Ave/116A, West Haven, CT 06516 (e-mail: benjamin.druss{at}yale.edu).
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