This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (76)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Quality of Care, Other  • Randomized Controlled Trial  • Alert me on articles by topic  Social Bookmarking   What's this?

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).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Health Care for Patients with Serious Mental Illness: Family Medicine's Role
Morden et al.
J Am Board Fam Med 2009;22:187-195.
ABSTRACT | FULL TEXT  

Barriers to the Delivery of Psychosocial Care for Cancer Patients: Bridging Mind and Body
Pincus and Patel
JCO 2009;27:661-662.
FULL TEXT  

The VA Psychiatry-Primary Care Education Initiative
Rohrbaugh et al.
Acad. Psychiatry 2009;33:31-36.
FULL TEXT  

Access to Medical Care Among Persons With Psychotic and Major Affective Disorders
Bradford et al.
Psychiatr. Serv. 2008;59:847-852.
ABSTRACT | FULL TEXT  

Improving Medical and Psychiatric Outcomes Among Individuals With Bipolar Disorder: A Randomized Controlled Trial
Kilbourne et al.
Psychiatr. Serv. 2008;59:760-768.
ABSTRACT | FULL TEXT  

Medical Clinic Characteristics and Access to Behavioral Health Services for Persons With HIV
Ohl et al.
Psychiatr. Serv. 2008;59:400-407.
ABSTRACT | FULL TEXT  

Medication-Induced Weight Gain and Dyslipidemia in Patients With Schizophrenia
Fenton and Chavez
Focus 2008;6:246-253.
ABSTRACT | FULL TEXT  

Best Practices: Surveillance and Management of Diabetes in a CMHC Population
Srihari et al.
Psychiatr. Serv. 2007;58:1151-1153.
ABSTRACT | FULL TEXT  

Metabolic disease and cardiovascular risk in people treated with antipsychotics in the community
Mackin et al.
Br. J. Psychiatry 2007;191:23-29.
ABSTRACT | FULL TEXT  

Quality of Diabetes Care Among Adults With Serious Mental Illness
Goldberg et al.
Psychiatr. Serv. 2007;58:536-543.
ABSTRACT | FULL TEXT  

Medication-Induced Weight Gain and Dyslipidemia in Patients With Schizophrenia
Fenton and Chavez
Am. J. Psychiatry 2006;163:1697-1704.
FULL TEXT  

Interrelationships of Psychiatric Symptom Severity, Medical Comorbidity, and Functioning in Schizophrenia
Chwastiak et al.
Psychiatr. Serv. 2006;57:1102-1109.
ABSTRACT | FULL TEXT  

From silos to bridges: meeting the general health care needs of adults with severe mental illnesses.
Horvitz-Lennon et al.
Health Aff (Millwood) 2006;25:659-669.
ABSTRACT | FULL TEXT  

Geropsychiatric Nursing: The State of the Science
Kolanowski and Piven
J Am Psychiatr Nurses Assoc 2006;12:75-99.
ABSTRACT  

Transforming Mental Health Care at the Interface With General Medicine: Report for the Presidents Commission
Unutzer et al.
Psychiatr. Serv. 2006;57:37-47.
ABSTRACT | FULL TEXT  

Connections to Primary Medical Care after Psychiatric Crisis
Griswold et al.
J Am Board Fam Med 2005;18:166-172.
ABSTRACT | FULL TEXT  

Effects on Processes and Costs of Care Associated With the Addition of an Internist to an Inpatient Psychiatry Team
Rubin et al.
Psychiatr. Serv. 2005;56:463-467.
ABSTRACT | FULL TEXT  

Prevalence, Severity, and Co-occurrence of Chronic Physical Health Problems of Persons With Serious Mental Illness
Jones et al.
Psychiatr. Serv. 2004;55:1250-1257.
ABSTRACT | FULL TEXT  

Providing a primary care service for psychiatric in-patients
Welthagen et al.
Psychiatr. Bull. 2004;28:167-170.
ABSTRACT | FULL TEXT  

Barriers to Primary Medical Care Among Patients at a Community Mental Health Center
Levinson Miller et al.
Psychiatr. Serv. 2003;54:1158-1160.
ABSTRACT | FULL TEXT  

Blood-Borne Infections and Persons With Mental Illness: Responding to Blood-Borne Infections Among Persons With Severe Mental Illness
Brunette et al.
Psychiatr. Serv. 2003;54:860-865.
ABSTRACT | FULL TEXT  

Using Qualitative Methods to Distill the Active Ingredients of a Multifaceted Intervention
Levinson Miller et al.
Psychiatr. Serv. 2003;54:568-571.
ABSTRACT | FULL TEXT  

The Future of Behavioral Health and Primary Care: Drowning in the Mainstream or Left on the Bank?
Pincus
Psychosomatics 2003;44:1-11.
FULL TEXT  

OTHER ARTICLES NOTED (Nov 01 to 18 Oct 02)
Evid. Based Nurs. 2003;6:e1-1.
FULL TEXT  

Use of General Medical Services by VA Patients With Psychiatric Disorders
Cradock-O'Leary et al.
Psychiatr. Serv. 2002;53:874-878.
ABSTRACT | FULL TEXT  

Integrated medical care in a mental health clinic improved quality of care and outcomes in serious mental disorders
Gray
Evid. Based Ment. Health 2002;5:46-46.
FULL TEXT