Evaluating the potential for primary care to serve as a mental health home for people with schizophrenia

Abstract

Objective Primary care-based medical homes could improve the coordination of mental health care for individuals with schizophrenia and comorbid chronic conditions. The objective of this paper is to examine whether persons with schizophrenia and comorbid chronic conditions engage in primary care regularly, such that primary care settings have the potential to serve as a mental health home. Method We examined the annual primary care and specialty mental health service utilization of adult North Carolina Medicaid enrollees with schizophrenia and at least one comorbid chronic condition who were in a medical home during 2007–2010. Using a fixed-effects regression approach, we also assessed the effect of medical home enrollment on utilization of primary care and specialty mental health care and medication adherence. Results A substantial majority (78.5%) of person-years had at least one primary care visit, and 17.9% had at least one primary care visit but no specialty mental health services use. Medical home enrollment was associated with increased use of primary care and specialty mental health care, as well as increased medication adherence. Conclusions Medical home enrollees with schizophrenia and comorbid chronic conditions exhibited significant engagement in primary care, suggesting that primary-care-based medical homes could serve a care coordination function for persons with schizophrenia.

Medicaid Value-Based Payments and Health Care Use for Patients With Mental Illness

“…Fifth, we stratified analyses by enrollees residing in New York City (NYC) vs non-NYC (eTables 25 and 26 in Supplement 1), and, for patients with schizophrenia, we stratified by comorbidity score (eTable 27 in Supplement 1). 32 See the eMethods in Supplement 1 for more details. Analyses were conducted using Stata, version 15 (StataCorp LLC).…”

“…Fifth, we stratified analyses by enrollees residing in New York City (NYC) vs non-NYC (eTables 25 and 26 in Supplement 1 ), and, for patients with schizophrenia, we stratified by comorbidity score (eTable 27 in Supplement 1 ). 32 …”

Effect of Enhanced Primary Care for People with Serious Mental Illness on Service Use and Screening

“…20 The PCMH model has been shown to improve some preventive screening and service use outcomes for people with SMI. [21][22][23][24] However, Bowdoin et al found that among people with mental illness, receiving care in a PCMH did not yield better preventive care or service use outcomes than having a non-PCMH usual source of care. 25,26 Enhancements to the PCMH model designed to meet the complex health needs of people with SMI may better leverage the potential of the model to serve this population, but evidence regarding what these enhancements should be is lacking.…”

Applying Care Coordination Principles to Reduce Cardiovascular Disease Risk Factors in People With Serious Mental Illness: A Case Study Approach

“…Care delivery models have sought to better integrate delivery of behavioral and physical healthcare, but these models have faced challenges. Models such as Collaborative Care (20)(21)(22) or the Patient Centered Medical Home (23)(24)(25), where behavioral health is integrated into primary care settings, may have primary care providers (PCPs) who lack experience in treating individuals with SMI (24). In the Behavioral Health Home (BHH), where the coordination of care for physical healthcare is centered in the specialty mental healthcare setting (26,27), behavioral health providers may not feel equipped to address CVD risk factors (28).…”