Programs to integrate physical health care services into specialty mental health clinics improved monitoring of psychiatric medication side effects, but did not improve other aspects of care among the seriously mentally ill.
Impact of a Mental Health Based Primary Care Program on Quality of Physical Health Care
Published in: Administration and Policy in Mental Health and Mental Health Services Research [Epub September 2017]. doi: 10.1007/s10488-017-0822-
Posted on RAND.org on September 19, 2017
- How did quality of care change among patients in the Primary Behavioral Health Care Integration (PBHCI) program in New York state, relative to those receiving care at clinics in the study’s control group?
We examine the impact of mental health based primary care on physical health treatment among community mental health center patients in New York State using propensity score adjusted difference in difference models. Outcomes are quality indicators related to outpatient medical visits, diabetes HbA1c monitoring, and metabolic monitoring of antipsychotic treatment. Results suggest the program improved metabolic monitoring for patients on antipsychotics in one of two waves, but did not impact other quality indicators. Ceiling effects may have limited program impacts. More structured clinical programs to may be required to achieve improvements in quality of physical health care for this population.
- Quality of laboratory monitoring of metabolic side effects of medications improved among clinics in wave 1 of PBHCI implementation, which had a follow-up period of four years.
- Other effects on extended scope of primary care practices that were targeted by the PBHCI program, such as having an outpatient medical visit and HbA1c monitoring, were not found among wave 1 clinics.
- Among wave 2 clinics, no targeted effects on quality of care were found.
- Lack of effect of the PBHCI program may be due to being implemented at clinics that were already providing relatively high quality of care for the targeted population.
- Integrated programs such as PBHCI may need longer periods of time to be able to show evidence of their effects.