Quality of diabetes care among adults with serious mental illness.
OBJECTIVE
The study compared the quality of care for type 2 diabetes delivered to two groups with type 2 diabetes--adults with serious mental illness and those with no serious mental illness--in a range of community-based clinic settings.


METHODS
Cross-sectional analyses of medical chart data from 300 patients (201 with serious mental illness and 99 without serious mental illness) were used to examine indicators of the quality of care established by the Diabetes Quality Improvement Project. Recommended services assessed included glycosylated hemoglobin examination, eye and foot examinations, blood pressure check, and urine and lipid profiles. Self-report data were used to compare receipt of provider-delivered diabetes education and receipt of cues regarding self-management of diabetes for the two study groups.


RESULTS
Evidence of lower quality of diabetes care was found for persons with serious mental illness as reflected by their receipt of fewer recommended services and less education about diabetes, compared with those without serious mental illness. Although participants with serious mental illness were less likely to receive cues from providers regarding the need for glucose self-monitoring, they were as likely as those without serious mental illness to receive cues regarding diet and medication adherence.


CONCLUSIONS
Although participants with serious mental illness received some services that are indicated in quality-of-care standards for diabetes, they were less likely to receive the full complement of recommended services and care support, suggesting that more effort may be required to provide optimal diabetes care to these vulnerable patients.
Goldberg
Richard W
RW
Mental Illness Research, Education and Clinical Center, Veterans Affairs Capitol Healthcare Network, Baltimore, MD, USA. rgoldber@psych.umaryland.edu
Kreyenbuhl
Julie A
JA
Medoff
Deborah R
DR
Dickerson
Faith B
FB
Wohlheiter
Karen
K
Fang
Li Juan
LJ
Brown
Clayton H
CH
Dixon
Lisa B
LB
D000328:Adult; D015142:Baltimore; D015190:Blood Glucose Self-Monitoring / Q000523:psychology / Q000592:standards; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000592:standards; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000628:therapy; D019984:Quality Indicators, Health Care / Q000592:standards; D011787:Quality of Health Care / Q000592:standards*; D012015:Reference Standards