title: Connections to primary medical care after psychiatric crisis.
abstract: BACKGROUND
  Patients presenting with a psychiatric emergency face a unique set of challenges in connecting to primary care.
  
  
  OBJECTIVE
  We tested the hypothesis that, in contrast to usual care, case management will result in higher rates of connection to primary care. We examined variables affecting primary care entry, including insurance status, hospital admission, and concurrent linkages to mental health care.
  
  
  METHODS
  This article reports on a preliminary outcome of an ongoing randomized controlled trial conducted with 101 patients presenting in an urban psychiatric setting. Patients were randomized to a case management team or to usual care. The need for medical care was assessed by documenting medical comorbidity.
  
  
  RESULTS
  Average age of the sample was 37.5; 65% were male, and 78% had low income; 37% were African American and 9% were Hispanic. Within 3 months of study enrollment, 57% of the intervention group was successfully linked to primary care compared with 16% of the usual care group, a difference that was statistically significant (P < .001). Associated positive predictors for linkage to primary care included mental health care visits and success in obtaining health insurance. Inpatient hospital stay at the time of psychiatric crisis was negatively associated with later attendance at primary care.
  
  
  CONCLUSIONS
  Case management intervention was effective in establishing linkage to primary care within 3 months. Ongoing work will evaluate primary care retention and physical and mental health outcomes.
authors.affiliation: Department of Family Medicine, Family Medicine Research Institute, The State University of New York at Buffalo, Buffalo, NY 14215, USA. griswol@buffalo.edu
authors.forename: Kim S
authors.initials: KS
authors.lastname: Griswold
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Servoss
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Leonard
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Pastore
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Smith
authors.forename: Christine
authors.initials: C
authors.lastname: Wagner
authors.forename: Margaret
authors.initials: M
authors.lastname: Stephan
authors.forename: Mary
authors.initials: M
authors.lastname: Thrist
mesh_terms: D000328:Adult; D019090:Case Management; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D004637:Emergency Services, Psychiatric / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D012959:Socioeconomic Factors