Medical house model improves mental health treatment

A medical home that provides conventional primary care focused on mental health appears to be an effective model for managing patients with serious psychiatric illnesses, according to new research.

Patients with serious mental illnesses such as schizophrenia and bipolar disorder are dying at rates 2.2 times higher than the general population. But people with these conditions – who often also suffer from cognitive deficits, have impaired social skills, are socially disadvantaged and have high rates of substance abuse – are less likely to receive primary care services and instead rely heavily on hospitals and emergency services for their medical care. care.

Clinicians at the University of California, Los Angeles (UCLA) and their colleagues sought to reverse these poor outcomes by addressing mental health issues at the primary care level.

They created a patient-centered medical home, a model of care designed to ensure that patients receive primary and mental health care on an ongoing basis to better manage chronic conditions and maintain wellness, rather than during separate and periodic visits to the doctor’s office.



Dr. Alex Young

“Few psychiatrists are trained in primary care or can provide these services. The same is true for primary care physicians, and we need to be able to better coordinate care for these vulnerable patients,” said Alex Young, MD. , lead author of the new study and director of the Semel Institute for Neuroscience and Human Behavior at UCLA’s David Geffen School of Medicine. “Our team’s study shows that a patient-centered medical home can be effective and should be considered to improve the health care of patients with serious mental illnesses.”

The first randomized controlled trial of the approach, published in the Journal of General Internal Medicine, covered an average of 401 days in a specialized patient-centered home within the Veterans Health Administration (VA) patient-aligned care teams.

Young and his colleagues divided 331 patients with serious mental illnesses — conditions included recurrent major depression with psychosis or chronic severe post-traumatic stress disorder — into two groups. One group included 164 patients who received integrated health care through a VA medical home staffed by a primary care physician and a charge nurse. In addition, a psychiatrist was available to the team by telephone, instant messaging or email.

The other group received care from a team of VA clinicians that included a physician or nurse practitioner and nurse, physician assistant, and clerks. However, they received their psychiatric care at a specialized mental health clinic rather than their primary care facility.

For 65 (40%) patients in the medical home group, mental health care was completely changed to being provided by primary care clinicians. Patients in the intervention group experienced greater improvements in measures of general health, such as body mass index, lipid levels, and blood sugar levels (P < .05). They also saw improvements in all aspects of care for chronic conditions, as well as in their experience of the care they received (P < .05) and in their emotional life (P = .05).

“While people with severe mental illness are among the most difficult and expensive patients to treat, it is possible to help people with severe mental illness to be healthy and productive, while minimizing their need for use hospital and emergency services,” Young, who is also associate director of the health services unit at the VA VISN 22 Mental Illness, Research, Education and Clinical Center, in Los Angeles, said. Medscape Medical News. “We have found this model of care to be effective in improving treatment appropriateness and patient outcomes.”

The model is both “viable and valuable for keeping patients healthy, out of hospitals and on the job,” said Andrew JP Carroll, MD, FAAFP, a family physician in Arizona. The results “are fantastic and show that the model is working, especially for patients with IMS,” he said. Medscape Medical News.

Carroll’s two clinics in Chandler and Flagstaff, Arizona operate under similar models that integrate primary care and mental health care with care from licensed behavior counselors. Since the services were launched 7 years ago to include behavior counselors, emergency room visits for all diagnoses have dropped by 20% to 25%, he said. “We need to reach a larger population of people where they can also get seamless services,” Carroll said.

The authors did not disclose any relevant financial relationship.

J Gen Med Intern. Published online April 5, 2022. Summary

Sharon Donovan is a New Orleans-based freelance writer who has written for ASCO Post, Pharmacy Practice News, and Clinical Oncology News, as well as daily newspapers, news agencies, and consumer magazines.

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