J Fotiades, Bronx VAMC/VISN 3 MIRECC; DA Smelson, Lyons VAMC, VISN 3 MIRECC; M Kaune, Lyons VAMC; M Losonczy, Lyons VAMC, VISN 3 MIRECC

Objectives: (1) To characterize the prevalence and incidence of medical co-morbidities in patients with SMI, institutionalized in a chronic psychiatric VA facility.

(2) To determine how well three major medical co-morbidities: Diabetes Mellitus (DM), Hypertension (HTN) and Ischemic Heart disease (IHD), are managed in this sample.

(3) To determine how well evidence-based preventive services are delivered to this sample.

Methods: The medical charts of 86 persistent SMI patients residing in the Lyons VAMC were reviewed from October 1,1998 to November 1,1999. The three wards chosen as a focus for this study included: a Geri-psychiatry unit, an open SMI unit, and a closed unit for SMI patients with behavioral problems. The charts were reviewed for the prevalence and incidence of medical co-morbidities, and adherence to evidenced-based treatment guidelines. The management of three chronic diseases was monitored using an average glycosylated hemoglobin (HbA1C) for DM, an average blood pressure (BP) for HTN, and an average LDL level for patients with IHD.

Results: The average age of the sample was 61.28 years and the average length of stay was 3 years and 4 months. The 3 most prevalent medical co-morbidities included: COPD (32.6%), HTN (32.6%) and PPD-positive (30.2%). There were no new medical co-morbidities recognized during this period. The average HbA1C for all diabetics in the sample was 6.29 mg/dl; the average BP for all hypertensives was 144/79 mm Hg. There was no LDL value on any of the IHD patients documented, to assess their management. 58.1 % of the sample received influenza vaccinations, 32.6% received pneumovax. 47.8% were screened for colo-rectal and 83.6% screened for prostate cancer.

Conclusions: The most prevalent medical conditions recognized in this sample of institutionalized SMI patients were: COPD, HTN and positive PPD. These medical conditions most likely arise from the unhealthy lifestyles common to this population. The medical management for the SMI patients with Diabetes and Hypertension appears to be effective in this setting. While certain preventive medicine measures such as influenza vaccinations and screening for prostate cancer appear to be done well, there is room for improvement. There is also a need to focus more on other preventive measures such as providing pneumovax and screening for colo-rectal cancer.

Impact: SMI patients have documented increased morbidity and mortality rates compared to the general population. The results of this study suggest that certain medical disorders such as HTN and DM may be effectively managed in a controlled setting, such as that of a chronic care institution. The prevalence of respiratory and circulatory conditions in this sample may be an effect of the unhealthy lifestyles seen in this population. This underscores the need for education and preventive medicine measures as an important focus for the provision of health services to the SMI patient.