Do primary care medical homes facilitate care transitions after psychiatric discharge for patients with multiple chronic conditions?

Abstract

Objective Primary-care-based medical homes may facilitate care transitions for persons with multiple chronic conditions (MCC) including serious mental illness. The purpose of this manuscript is to assess outpatient follow-up rates with primary care and mental health providers following psychiatric discharge by medical home enrollment and medical complexity. Methods Using a quasi-experimental design, we examined data from NC Medicaid-enrolled adults with MCC hospitalized with an inpatient diagnosis of depression or schizophrenia during 2008-2010. We used inverse-probability-of-treatment weighting and assessed associations between medical home enrollment and outpatient follow-up within 7 and 30 days post discharge. Results Medical home enrollees (n=16,137) were substantially more likely than controls (n= 11,304) to receive follow-up care with any provider 30 days post discharge. Increasing patient complexity was associated with a greater probability of primary care follow-up. Medical complexity and medical home enrollment were not associated with follow-up with a mental health provider. Conclusions Hospitalized persons with MCC including serious mental illness enrolled in a medical home were more likely to receive timely outpatient follow-up with a primary care provider, but not with a mental health specialist. These findings suggest that the medical home model may be more adept at linking patients to providers in primary care rather than to specialty mental health providers.

Associations between the patient-centered medical home and preventive care and healthcare quality for non-elderly adults with mental illness: A surveillance study analysis

“…The results of this study contrast with those of prior studies which indicated that the PCMH may be associated with better medication adherence [ 19 , 20 ], receipt of preventive screenings [ 20 ], and outpatient follow-up after psychiatric discharge [ 21 ] for non-elderly adults with mental illness. The differences in study findings, however, could be attributed to methodological differences between the studies.…”

“…Prior systematic reviews have found mixed results for the PCMH overall [ 14 – 18 ], but three retrospective cohort studies conducted with non-elderly adults with mental illness enrolled in the North Carolina Medicaid program indicated that the PCMH may have favorable effects on medication adherence [ 19 , 20 ], preventive screenings [ 20 ], and outpatient follow-up after psychiatric discharge [ 21 ]. A study conducted with 9,303 North Carolina Medicaid-enrolled non-elderly adults with depression and at least one other chronic condition found that enrollees who had a PCMH had better rates of antidepressant adherence than those without a PCMH [ 19 ].…”

“…The authors also found that, among participants with major depression, having a PCMH was associated with better rates of lipid and cancer screening. A third study conducted with North Carolina Medicaid-enrolled non-elderly adults with multiple chronic conditions and a hospitalization for either schizophrenia ( N = 8,783) or depression ( N = 18,658) found that those with a PCMH were more likely to receive follow-up care with any provider and with a primary care provider within 30 days post-discharge [ 21 ]. To our knowledge, no other peer-reviewed studies have examined the association between the PCMH and receipt of recommended preventive care or better healthcare quality for non-elderly adults with mental illness.…”

Health, Social, and Functional Characteristics of Older Adults With Continuing Care Needs: Implications for Integrated Care

“…Furthermore, this study reemphasizes the importance of considering mental as well as physical needs of older adults in health service design and delivery. Health care systems continue to silo acute services into psychiatric and physical services, and in the community, primary care services focus primarily on physical health (Domino et al, 2016). Mental illness decreases the capacity of older adults to self-manage physical conditions, such as learning or remembering how to use respiratory medications, or monitor heart failure symptoms.…”

Continuity of medication management among adults with schizophrenia and comorbid cardiometabolic conditions

“…These results may also highlight additional tools that can be used to improve care coordination, including use of pharmacist case managers or the medical home model, which has shown success in improving care in persons with severe mental illness. [25][26][27][28] For example, having adults with multiple discordant chronic conditions (such as CMCs and schizophrenia) who receive prescriptions from multiple providers designate a pharmacist case manager or establishing a PCP-based medical home may be associated with reductions in the potential for drug interactions, duplicate drug therapies or laboratory tests and provider role confusion (although not explicitly modeled in this study) that may occur when multiple, uncoordinated prescribers are involved in care.…”