General Medical Outcomes From the Primary and Behavioral Health Care Integration Grant Program

• Published in: Psychiatric services (Washington, D.C.) Vol. 67; no. 11; pp. 1226 - 1232
• Main Authors: Scharf, Deborah M, Schmidt Hackbarth, Nicole, Eberhart, Nicole K, Horvitz-Lennon, Marcela, Beckman, Robin, Han, Bing, Pincus, Harold Alan, Burnam, M. Audrey
• Format: Journal Article
• Language: English
• Published: United States American Psychiatric Association 01-11-2016; American Psychiatric Publishing, Inc
• Subjects: Adult; Data collection; Delivery of Health Care, Integrated - statistics & numerical data; Experiments; Female; Grants; Humans; Lipoproteins; Male; Mental disorders; Mental Health Services - statistics & numerical data; Middle Aged; Outcome and Process Assessment (Health Care) - statistics & numerical data; Primary Health Care - statistics & numerical data; United States
• ISSN: 1075-2730; 1557-9700
• DOI: 10.1176/appi.ps.201500352

Objective:Primary and Behavioral Health Care Integration (PBHCI) grants aim to improve the health of people with serious mental illness by integrating primary and preventive general medical services into behavioral health settings. This report describes the general medical outcomes of persons served by early cohorts of programs, funded in 2009 or 2010, that participated in this national demonstration project.Methods:A quasi-experimental, difference-in-differences design was used to compare changes in general medical health among consumers served at three PBHCI clinics (N=322) and three clinics that were selected as matched control sites (N=469). Propensity-score weighting was used to adjust for baseline differences between PBHCI and control clinic populations. Baseline data were collected between 2010 and 2012; follow-up data were collected approximately one year later. General medical outcomes included blood pressure; body mass index; cholesterol, triglyceride, and blood glucose or HbA1c levels; and self-reported tobacco smoking.Results:Compared with consumers served at control clinics, PBHCI consumers had better outcomes for cholesterol: mean reductions in total cholesterol were greater by 36 mg/dL (p<.01), mean reductions in low-density lipoprotein cholesterol were greater by 35 mg/dL (p<.001), and mean increases in high-density lipoprotein cholesterol were greater by 3 mg/dL (p<.05). No significant PBHCI effects were observed for the other health indicators.Conclusions:Approximately one year of PBHCI treatment resulted in statistically and potentially clinically significant improvements in cholesterol but not in other general medical outcomes examined. More rigorous implementation of integrated care in community behavioral health settings may be needed to further improve the health of adults with serious mental illness.