Veterans with Serious Mental Illness Using Co-Located/Integrated Primary Care and Outpatient Mental Health Clinic Care have Reduced Cardiovascular Risk
Cardiovascular risk factors are common among patients with serious mental illness (SMI), such as schizophrenia and bipolar disorder. However, patients with SMI primarily seek care for mental health conditions rather than physical conditions, thus their cardiovascular risk factors are commonly missed or ignored. Co-location and integration of primary care services into the mental health setting may reduce some of the barriers to delivery and receipt of high quality medical care for those with SMI. This study explored the effect of enrollment in a primary care clinic co-located and integrated into an outpatient mental health program on service use and control of cardiovascular risk among 97 Veterans with SMI, who previously demonstrated limited use of primary care services. The Serious Mental Illness Primary Care Clinic (SMIPCC) was implemented at the Providence VAMC in 2008. To be enrolled in SMIPCC, a Veteran must have a chronic and active mental health condition that leads to frequent use of mental health services. Using VA data, investigators assessed patient demographics, comorbid medical and psychiatric conditions, and VA service connection. They also examined four observation windows: the two successive six-month periods in the year prior to enrollment in SMIPCC, and the first and second six-month periods during enrollment. During these time periods, investigators examined patients' blood pressure, body mass index (BMI), LDL, HDL, triglycerides, and, among Veterans with diabetes, hemoglobin A1c (HbA1c).
- Veterans with SMI were more likely to attain cardiovascular risk goals after being enrolled in a primary care clinic co-located and integrated into an outpatient mental health clinic.
- Compared to prior to enrollment, Veterans enrolled in SMIPCC had significantly more primary care visits over six months — and significantly improved BP, LDL, triglycerides, and BMI. There were no significant differences in the attainment of goals for HDL or HbA1c.
- Prior to enrollment, 49% of primary care visits were on the same day as any scheduled mental health visit; this increased to 86% post-enrollment.
- Among the 28 Veterans in this study with coronary artery disease and/or diabetes, SMIPCC enrollment was associated with a significant improvement in BP goal attainment, but not with any other measures.
- This study was conducted at a single site.
- This study lacked concurrent controls and an economic analysis to determine cost-benefit.
All authors are part of HSR&D's Systems Outcomes and Quality in Chronic Disease and Rehabilitation (SOQCR), Providence, RI.
Pirraglia P, Rowland E, Wu W-C, Taveira T, Cohen L, Friedmann P, and O’Toole T. The Benefits of a Primary Care Clinic Co-Located and Integrated in the Mental Health Setting for Veterans with Serious Mental Illness. Preventing Chronic Disease February 2012;9:E51.