Benefits of a primary care clinic co-located and integrated in a mental health setting for veterans with serious mental illness.
BACKGROUND
Efficacy trials have shown that primary care co-located in the mental health setting improves the receipt of high-quality medical care among people with serious mental illness. We tested whether implementation of such a program affected health service use and cardiovascular risk factor control among veterans with serious mental illness who had previously demonstrated limited primary care engagement.


METHODS
We performed a cohort study of veterans enrolled in a co-located, integrated primary care clinic in the mental health outpatient unit through targeted chart review. Two successive 6-month periods in the year before and in the year following enrollment in the co-located primary care clinic were examined for primary care and emergency department use and for goal attainment of blood pressure, fasting blood lipids, body mass index (BMI), and, among patients with diabetes, hemoglobin A1c (HbA1c). We used repeated-measures logistic regression to analyze goal attainment and repeated measures Poisson regression to analyze service use.


RESULTS
Compared with the period before enrollment, the 97 veterans enrolled in the clinic had significantly more primary care visits during 6 months and significantly improved goal attainment for blood pressure, low-density lipoprotein cholesterol, triglycerides, and BMI. Changes with regard to goal attainment for high-density lipoprotein cholesterol and HbA1c were not significant.


CONCLUSIONS
Enrollment in a co-located, integrated clinic was associated with increased primary care use and improved attainment of some cardiovascular risk goals among veterans with serious mental illness. Such a clinic can be implemented effectively in the mental health setting.
Systems Outcomes and Quality in Chronic Disease and Rehabilitation, Providence VA Medical Center, 830 Chalkstone Ave, Bldg 32, Providence, RI 02908, USA. paul.pirraglia@va.gov
Paul A
PA
Pirraglia
Emily
E
Rowland
Wen-Chih
WC
Wu
Peter D
PD
Friedmann
Thomas P
TP
O'Toole
Lisa B
LB
Cohen
Tracey H
TH
Taveira
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001714:Bipolar Disorder / Q000628:therapy*; D002318:Cardiovascular Diseases / Q000517:prevention & control; D015331:Cohort Studies; D003266:Continuity of Patient Care; D019033:Delivery of Health Care, Integrated / Q000379:methods; D006302:Health Services Research; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D011314:Preventive Health Services; D011320:Primary Health Care / Q000458:organization & administration*; D011618:Psychotic Disorders / Q000628:therapy*; D012307:Risk Factors; D012559:Schizophrenia / Q000628:therapy*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans