Integrated medical care in a mental health clinic improved quality of care and outcomes in serious mental disorders.

QUESTION: In patients with serious mental disorders, is integrated medical care given in a mental health clinic better than usual care given in a general medicine clinic for improving outcomes?DesignRandomised (unclear allocation concealment*), unblinded*, controlled trial with 1 year of follow up.SettingA Veterans Affairs mental health clinic in West Haven, Connecticut, USA.Patients120 patients (mean age 45 y, 99% men) who had serious mental disorders and would benefit from primary care. Exclusion criteria included having a current primary care provider, urgent or multiple serious chronic problems, and medical hospital admissions in the past 6 months. Follow up was 100% for service use, quality of preventive care, and costs; random regression was used to account for missing health status data.Intervention59 patients were allocated to integrated care and 61 to usual care. For integrated care, clinic staff emphasised patient education, preventive services, and close contact with mental health care providers. Patients also received telephone reminders before appointments, and whenever possible, clinical appointments were scheduled immediately after mental health visits. When appointments were missed, clinic staff made active efforts to reschedule visits. Patients in the usual care group were assigned to a primary care provider.Main outcome measuresService use (medical and psychiatric visits), quality of preventive care (17 preventive measures), physical (physical component summary of the 36 Item Short Form Health Survey) and mental health status (Symptom Checklist 90 and Addiction Severity Index), and costs in US$.Main resultsAnalysis was by intention to treat. More patients in the integrated care group than the usual care group made primary care visits (p=0.006) (table) and received 15 of 17 preventive measures at 1 year (all p values < 0.05). Fewer patients in the integrated care group than the usual care group made emergency department visits at 1 year (p=0.04) (table). Improvement in physical health status over 1 year was greater in the integrated care group than the usual care group (mean change from baseline score 4.7 v -0.3, p < 0.001). Primary care costs per patient were greater in the integrated care group than the usual care group (US$1582 v $398, p=0.02), but total healthcare costs did not differ.ConclusionIn patients with serious mental disorders, integrated medical care given in a mental health clinic was better than usual care in a general medicine clinic for improving access to primary care services, quality of preventive care, and health related quality of life.*See glossary. [ABSTRACT FROM AUTHOR]