scholarly journals The association between primary care quality and health-care use, costs and outcomes for people with serious mental illness: a retrospective observational study

2020 ◽  
Vol 8 (25) ◽  
pp. 1-126
Author(s):  
Rowena Jacobs ◽  
Lauren Aylott ◽  
Ceri Dare ◽  
Tim Doran ◽  
Simon Gilbody ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Illness ◽  
Confidence Interval ◽  
Serious Mental Illness ◽  
Hazard Ratio ◽  
Accident And Emergency ◽  
Quality And Outcomes ◽  
Quality And Outcomes Framework

Background Serious mental illness, including schizophrenia, bipolar disorder and other psychoses, is linked with high disease burden, poor outcomes, high treatment costs and lower life expectancy. In the UK, most people with serious mental illness are treated in primary care by general practitioners, who are financially incentivised to meet quality targets for patients with chronic conditions, including serious mental illness, under the Quality and Outcomes Framework. The Quality and Outcomes Framework, however, omits important aspects of quality. Objectives We examined whether or not better quality of primary care for people with serious mental illness improved a range of outcomes. Design and setting We used administrative data from English primary care practices that contribute to the Clinical Practice Research Datalink GOLD database, linked to Hospital Episode Statistics, accident and emergency attendances, Office for National Statistics mortality data and community mental health records in the Mental Health Minimum Data Set. We used survival analysis to estimate whether or not selected quality indicators affect the time until patients experience an outcome. Participants Four cohorts of people with serious mental illness, depending on the outcomes examined and inclusion criteria. Interventions Quality of care was measured with (1) Quality and Outcomes Framework indicators (care plans and annual physical reviews) and (2) non-Quality and Outcomes Framework indicators identified through a systematic review (antipsychotic polypharmacy and continuity of care provided by general practitioners). Main outcome measures Several outcomes were examined: emergency admissions for serious mental illness and ambulatory care sensitive conditions; all unplanned admissions; accident and emergency attendances; mortality; re-entry into specialist mental health services; and costs attributed to primary, secondary and community mental health care. Results Care plans were associated with lower risk of accident and emergency attendance (hazard ratio 0.74, 95% confidence interval 0.69 to 0.80), serious mental illness admission (hazard ratio 0.67, 95% confidence interval 0.59 to 0.75), ambulatory care sensitive condition admission (hazard ratio 0.73, 95% confidence interval 0.64 to 0.83), and lower overall health-care (£53), primary care (£9), hospital (£26) and mental health-care costs (£12). Annual reviews were associated with reduced risk of accident and emergency attendance (hazard ratio 0.80, 95% confidence interval 0.76 to 0.85), serious mental illness admission (hazard ratio 0.75, 95% confidence interval 0.67 to 0.84), ambulatory care sensitive condition admission (hazard ratio 0.76, 95% confidence interval 0.67 to 0.87), and lower overall health-care (£34), primary care (£9) and mental health-care costs (£30). Higher general practitioner continuity was associated with lower risk of accident and emergency presentation (hazard ratio 0.89, 95% confidence interval 0.83 to 0.97) and ambulatory care sensitive condition admission (hazard ratio 0.77, 95% confidence interval 0.65 to 0.92), but not with serious mental illness admission. High continuity was associated with lower primary care costs (£3). Antipsychotic polypharmacy was not statistically significantly associated with the risk of unplanned admission, death or accident and emergency presentation. None of the quality measures was statistically significantly associated with risk of re-entry into specialist mental health care. Limitations There is risk of bias from unobserved factors. To mitigate this, we controlled for observed patient characteristics at baseline and adjusted for the influence of time-invariant unobserved patient differences. Conclusions Better performance on Quality and Outcomes Framework measures and continuity of care are associated with better outcomes and lower resource utilisation, and could generate moderate cost savings. Future work Future research should examine the impact of primary care quality on measures that capture broader aspects of health and functioning. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 25. See the NIHR Journals Library website for further project information.

scholarly journals Glucose Control and Medication Adherence Among Veterans With Diabetes and Serious Mental Illness: Does Collocation of Primary Care and Mental Health Care Matter?

Diabetes Care ◽  
2014 ◽  
Vol 37 (8) ◽  
pp. 2261-2267 ◽  
Author(s):  
Judith A. Long ◽  
Andrew Wang ◽  
Elina L. Medvedeva ◽  
Susan V. Eisen ◽  
Adam J. Gordon ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Illness ◽  
Medication Adherence ◽  
Mental Health Care ◽  
Serious Mental Illness ◽  
Glucose Control

scholarly journals Creating a ‘reverse’ integrated primary and mental healthcare clinic for those with serious mental illness

2015 ◽  
Vol 17 (05) ◽  
pp. 421-427 ◽  
Author(s):  
Alexandros Maragakis ◽  
Ragavan Siddharthan ◽  
Jill RachBeisel ◽  
Cassandra Snipes
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Quality Of Care ◽  
Serious Mental Illness ◽  
Mental Healthcare ◽  
Policy Reforms ◽  
Mental Health Settings ◽  
Primary Care Practitioners

Individuals with serious mental illness (SMI) are more likely to experience preventable medical health issues, such as diabetes, hyperlipidemia, obesity, and cardiovascular disease, than the general population. To further compound this issue, these individuals are less likely to seek preventative medical care. These factors result in higher usage of expensive emergency care, lower quality of care, and lower life expectancy. This manuscript presents literature that examines the health disparities this population experiences, and barriers to accessing primary care. Through the identification of these barriers, we recommend that the field of family medicine work in collaboration with the field of mental health to implement ‘reverse’ integrated care (RIC) systems, and provide primary care services in the mental health settings. By embedding primary care practitioners in mental health settings, where individuals with SMI are more likely to present for treatment, this population may receive treatment for somatic care by experts. This not only would improve the quality of care received by patients, but would also remove the burden of managing complex somatic care from providers trained in mental health. The rationale for this RIC system, as well as training and policy reforms, are discussed.

scholarly journals Evaluating agency-led adaptions to an evidence-based lifestyle intervention for adults with serious mental illness

2020 ◽  
Vol 1 ◽  
pp. 263348952094320
Author(s):  
Kelly A Aschbrenner ◽  
Gary R Bond ◽  
Sarah I Pratt ◽  
Kenneth Jue ◽  
Gail Williams ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Mental Health Care ◽  
Serious Mental Illness ◽  
Real World ◽  
Evidence Based ◽  
Cardiovascular Risk Reduction ◽  
Evidence Based Practices ◽  
Practical Advantage

Background: Limited empirical evidence exists on the impact of adaptations that occur in implementing evidence-based practices (EBPs) in real-world practice settings. The purpose of this study was to measure and evaluate adaptations to an EBP (InSHAPE) for obesity in persons with serious mental illness in a national implementation in mental health care settings. Methods: We conducted telephone interviews with InSHAPE provider teams at 37 (95%) of 39 study sites during 24-month follow-up of a cluster randomized trial of implementation strategies for InSHAPE at behavioral health organizations. Our team rated adaptations as fidelity-consistent or fidelity-inconsistent. Multilevel regression models were used to estimate the relationship between adaptations and implementation and participant outcomes. Results: Of 37 sites interviewed, 28 sites (76%) made adaptations to InSHAPE ( M = 2.1, SD = 1.3). Sixteen sites (43%) made fidelity-consistent adaptations, while 22 (60%) made fidelity-inconsistent adaptations. The number of fidelity-inconsistent adaptations was negatively associated with InSHAPE fidelity scores (β = −4.29; p < .05). A greater number of adaptations were associated with significantly higher odds of participant-level cardiovascular risk reduction (odds ratio [ OR] = 1.40; confidence interval [CI] = [1.08, 1.80]; p < .05). With respect to the type of adaptation, we found a significant positive association between the number of fidelity-inconsistent adaptations and cardiovascular risk reduction ( OR = 1.59; CI = [1.01, 2.51]; p < .05). This was largely explained by the fidelity-inconsistent adaptation of holding exercise sessions at the mental health agency versus a fitness facility in the community (a core form of InSHAPE) ( OR = 2.52; 95% CI = [1.11, 5.70]; p < .05). Conclusions: This research suggests that adaptations to an evidence-based lifestyle program were common during implementation in real-world mental health practice settings even when fidelity was monitored and reinforced through implementation interventions. Results suggest that adaptations, including those that are fidelity-inconsistent, can be positively associated with improved participant outcomes when they provide a potential practical advantage while maintaining the core function of the intervention. Plain language abstract: Treatments that have been proven to work in research studies are not always one-size-fits-all. In real-world clinical settings where people receive mental health care, sometimes there are good reasons to change certain things about a treatment. For example, a particular treatment might not fit well in a specific clinic or cultural context, or it might not meet the needs of specific patient groups. We studied adaptations to an evidence-based practice (InSHAPE) targeting obesity in persons with serious mental illness made by teams implementing the program in routine mental health care settings. We learned that adaptations to InSHAPE were common, and that an adaptation that model experts initially viewed as inconsistent with fidelity to the model turned out to have a positive impact on participant health outcomes. The results of this study may encourage researchers and model experts to work collaboratively with mental health agencies and clinicians implementing evidence-based practices to consider allowing for and guiding adaptations that provide a potential practical advantage while maintaining the core purpose of the intervention.

scholarly journals Does the quality and outcomes framework reduce psychiatric admissions in people with serious mental illness? A regression analysis

BMJ Open ◽  
2015 ◽  
Vol 5 (4) ◽  
pp. e007342-e007342 ◽  
Author(s):  
N. Gutacker ◽  
A. R. Mason ◽  
T. Kendrick ◽  
M. Goddard ◽  
H. Gravelle ◽  
...  
Keyword(s):  
Mental Illness ◽  
Regression Analysis ◽  
Serious Mental Illness ◽  
Psychiatric Admissions ◽  
Quality And Outcomes ◽  
Quality And Outcomes Framework

Deinstitutionalization and The Homeless Mentally Ill

2020 ◽  
Vol 3 (01) ◽  
pp. 1-3
Author(s):  
Sarada Menon ◽  
Jayakumar Menon ◽  
P. Poornachandrika
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Special Needs ◽  
Serious Mental Illness ◽  
Mentally Ill ◽  
Critical Evaluation ◽  
Homeless Mentally Ill ◽  
Public Body ◽  
Oxford Dictionary

According to the Oxford dictionary “Institution” is an important public body, a home providing care for people with special needs and ‘institutionalise’ is placing such persons in a residential institution. In the context of the topic being discussed, institution is a home for persons with special needs and similarly institutionalisation is placing the persons with serious mental illness, whether acute, subacute or chronic. Deinstitutionalisation is increasingly being projected as the most needed reform in the mental health care by many experts in our country, but the implications of this merit’s critical evaluation.

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