Mind and Body Reunited: Improving Care at the Behavioral and Primary Healthcare Interface

Close to 19 million US adults have severe mental illnesses (SMI), and they die, on average, 25 years earlier than the general population, most often from cardiovascular disease (CVD). Many of the antipsychotic medications used to treat SMI contribute to CVD risk by increasing risk for obesity, type 2 diabetes, dyslipidemia, and hypertension. Based on compelling evidence, the American Diabetes Association and the American Psychiatric Association developed guidelines for metabolic screening and monitoring during use of these medications. In this manuscript, we have reviewed the evidence on diabetes and other CVD risk screening, prevalence, and management among populations with SMI. We also review differences in screening among subpopulations with SMI (e.g., racial/ethnic minorities, women, and children). We found that despite national guidelines for screening for diabetes and other cardiovascular risk factors, up to 70 % of people taking antipsychotics remain unscreened and untreated. Based on estimates that 20 % of the 19 million US adults with SMI have diabetes and 70 % of them are not screened; it is likely that over 2 million Americans with SMI have unidentified diabetes. Given that undiagnosed diabetes costs over $4,000 per person, this failure to identify diabetes among people with SMI represents a missed opportunity to prevent morbidity and translates to over $8 billion in annual preventable costs to our healthcare system. Given the high burden of disease and significant evidence of suboptimal medical care received by people with SMI, we propose several clinical and policy recommendations to improve diabetes and other CVD risk screening and care for this highly vulnerable population. These recommendations include reducing antipsychotic medication dose or switching antipsychotic medications, enhancing smoking cessation efforts, sharing electronic health records between physical and mental health care systems, and promoting integration of care.KEY WORDS: mental illness; diabetes; integration of care.

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“…24 In addition to smoking, other behavioral factors are prevalent among this population, including poor diet and lack of exercise. 25 …”

Section: Smi and Tobacco Usementioning

confidence: 99%

Diabetes and Cardiovascular Care Among People with Severe Mental Illness: A Literature Review

et al. 2016

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“…A number of barriers to delivery of integrated care 21 have been overcome through the federal parity law and the ACA including lack of coverage for mental health and substance use disorders and differential cost-sharing between behavioral health and general medical care. Health plan contracting arrangements and payment policies remain key to supporting a move toward more integrated care.…”

Section: Discussionmentioning

confidence: 99%

“…Health plan contracting arrangements and payment policies remain key to supporting a move toward more integrated care. 21 …”

Section: Discussionmentioning

confidence: 99%

The Role of Health Plans in Supporting Behavioral Health Integration

Stewart

Horgan

Quinn

et al. 2017

Adm Policy Ment Health

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Health plan policies can influence delivery of integrated behavioral health and general medical care. This study provides national estimates for the prevalence of practices used by health plans that may support behavioral health integration. Results indicate that health plans employ financing and other policies likely to support integration. They also directly provide services that facilitate integration. Behavioral health contracting arrangements are associated with use of these policies. Delivery of integrated care requires systemic changes by both providers and payers thus health plans are key players in achieving this goal.

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“…Aunque en algunos casos las clasificaciones obedecían a una finalidad descriptiva en países concre tos 2729,35,63 , en general pretendían ofrecer esquemas comparativos, identificándose tres principales: El denominado esquema de los cuatro cuadrantes, en el que el papel de AP y SM se distribuye según la gravedad en las dimen siones física y mental de la salud, a partir del cual se desarrollan diversas tipologías de modelos 9,30,31,74 .…”

Section: Tabla 2 Evaluación De La Calidad De Las Revisionesunclassified

Modelos de colaboración entre atención primaria y salud mental en la asistencia sanitaria a las personas con depresión: resultados principales y retos metodológicos de una meta-revisión sistemática

Gómez

Mosquera

Gea

et al. 2014

Rev. Esp. Salud Publica

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RESUMENFundamentos: Las carencias en la colaboración entre Atención Primaria (AP) y Salud Mental (SM) constituyen un problema relevante en la atención a los pacientes con depresión. Resulta necesario analizar y evaluar los mode los de colaboración existentes para valorar su aplicabilidad en el sistema de salud español. El objetivo del presente estudio es conocer las principales ca racterísticas de los distintos modelos de colaboración APSM en la atención a los pacientes diagnosticados de depresión y la calidad de la evidencia cientí fica acerca de su efectividad.Métodos: Metarevisión sistemática de los estudios secundarios publi cados entre 2001 y 2010 en MEDLINE, PsycINFO, Embase, LILACS, IBECS, IME y la Biblioteca Cochrane. Las revisiones se evaluaron mediante la herramienta AMSTAR. Se realizó una síntesis aproximativa de la calidad de las evidencias encontradas.Resultados: Se evaluaron 69 estudios. La variabilidad según contextos y las carencias metodológicas condicionan que la calidad de las evidencias sea en general baja o dudosa. Las estrategias más efectivas integran intervencio nes de responsabilización en el seguimiento de los pacientes, rediseños en la gestión, e información y comunicación compartidas. Las metarevisiones de estudios secundarios sobre modelos colaborativos favorecen la accesibilidad a las evidencias publicadas, pero conllevan importantes retos metodológicos.Conclusiones: La calidad de la evidencia sobre la efectividad de los mo delos de colaboración APSM durante la atención sanitaria a las personas con depresión es predominantemente baja o dudosa y su significado y aplicabili dad son menores cuanto más se simplifica el análisis de sus componentes, procesos y circunstancias de implementación.

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Mind and Body Reunited: Improving Care at the Behavioral and Primary Healthcare Interface

Cited by 36 publications

References 40 publications

Diabetes and Cardiovascular Care Among People with Severe Mental Illness: A Literature Review

Diabetes and Cardiovascular Care Among People with Severe Mental Illness: A Literature Review

The Role of Health Plans in Supporting Behavioral Health Integration

Modelos de colaboración entre atención primaria y salud mental en la asistencia sanitaria a las personas con depresión: resultados principales y retos metodológicos de una meta-revisión sistemática

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