Quality of medical care for persons with serious mental illness: A comprehensive review

Abstract

Objectives Prior studies suggest variation in the quality of medical care for somatic conditions such as cardiovascular disease and diabetes provided to persons with SMI, but to date no comprehensive review of the literature has been conducted. The goals of this review were to summarize the prior research on quality of medical care for the United States population with SMI; identify potential sources of variation in quality of care; and identify priorities for future research. Methods Peer-reviewed studies were identified by searching four major research databases and subsequent reference searches of retrieved articles. All studies assessing quality of care for cardiovascular disease, diabetes, dyslipidemia, and HIV/AIDs among persons with schizophrenia and bipolar disorder published between January 2000 and December 2013 were included. Quality indicators and information about the study population and setting were abstracted by two trained reviewers. Results Quality of medical care in the population with SMI varied by study population, time period, and setting. Rates of guideline-concordant care tended to be higher among veterans and lower among Medicaid beneficiaries. In many study samples with SMI, rates of guideline adherence were considerably lower than estimated rates for the general US population. Conclusions Future research should identify and address modifiable provider, insurer, and delivery system factors that contribute to poor quality of medical care among persons with SMI and consider how to best use quality performance measures as part of the larger strategy to improve health for this group.

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

“…[61][62][63][64] In one VA study from 2001-2005, only 11 % of people with comorbid diabetes and SMI received medications to treat diabetes. 36 In a community sample, among people with schizophrenia who reported they had diabetes, 41 % reported not receiving antihyperglycemic treatment.…”

Primary and Secondary HIV Prevention Among Persons with Severe Mental Illness: Recent Findings

“…In a review, McGinty and colleagues found that the rate of ART receipt for persons with SMI in the U.S. (ranging from 51%–83% across studies) was below the recommended guidelines (85%) [38]. A similar trend has been noted in low and middle-income countries, where ART has traditionally been denied to persons with SMI.…”

“…Reasons for this disparity are multifaceted and include individual factors (e.g., health behaviors, medication induced weight gain, functional limitations) and social determinants (e.g., poverty, neighborhood, social supports) that contribute to poor health and reduced access to quality care, including HIV care. A recent review of the overall healthcare quality for individuals living with SMI in the U.S. revealed that antiretroviral therapy (ART) was less often prescribed for persons with SMI compared to the general population; however there was not a disparity for CD4 count and viral load monitoring [38]. Disparities in general and HIV-specific medical treatment for individuals living with SMI are global problems.…”

Physical activity and metabolic disease among people with affective disorders: Prevention, management and implementation

“…Once an established diagnosis of metabolic syndrome or T2DM is made, many of those with affective disorders are not offered timely treatment (McGinty et al, 2015). Thus, routine screening and prevention of metabolic abnormalities is only the first step.…”