title: Glucose control and medication adherence among veterans with diabetes and serious mental illness: does collocation of primary care and mental health care matter?
abstract: OBJECTIVE
  Persons with serious mental illness (SMI) may benefit from collocation of medical and mental health healthcare professionals and services in attending to their chronic comorbid medical conditions. We evaluated and compared glucose control and diabetes medication adherence among patients with SMI who received collocated care to those not receiving collocated care (which we call usual care).
  
  
  METHODS
  We performed a cross-sectional, observational cohort study of 363 veteran patients with type 2 diabetes and SMI who received care from one of three Veterans Affairs medical facilities: two sites that provided both collocated and usual care and one site that provided only usual care. Through a survey, laboratory tests, and medical records, we assessed patient characteristics, glucose control as measured by a current HbA1c, and adherence to diabetes medication as measured by the medication possession ration (MPR) and self-report.
  
  
  RESULTS
  In the sample, the mean HbA1c was 7.4% (57 mmol/mol), the mean MPR was 80%, and 51% reported perfect adherence to their diabetes medications. In both unadjusted and adjusted analyses, there were no differences in glucose control and medication adherence by collocation of care. Patients seen in collocated care tended to have better HbA1c levels (β = -0.149; P = 0.393) and MPR values (β = 0.34; P = 0.132) and worse self-reported adherence (odds ratio 0.71; P = 0.143), but these were not statistically significant.
  
  
  CONCLUSIONS
  In a population of veterans with comorbid diabetes and SMI, patients on average had good glucose control and medication adherence regardless of where they received primary care.
authors.affiliation: Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PADepartment of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA jalong@mail.med.upenn.edu.
authors.forename: Judith A
authors.initials: JA
authors.lastname: Long
authors.affiliation: Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wang
authors.affiliation: Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA.
authors.forename: Elina L
authors.initials: EL
authors.lastname: Medvedeva
authors.affiliation: Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MABoston University School of Public Health, Boston, MA.
authors.forename: Susan V
authors.initials: SV
authors.lastname: Eisen
authors.affiliation: Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PAMental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PAUniversity of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Gordon
authors.affiliation: Mental Illness Research, Education and Clinical Center, VA Capitol Health Care Network, Baltimore, MDDivision of Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Julie
authors.initials: J
authors.lastname: Kreyenbuhl
authors.affiliation: Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PAPenn School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Marcus
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D008605:Mental Health Services / Q000458:organization & administration; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000458:organization & administration; D014728:Veterans / Q000706:statistics & numerical data*; D016903:Drug Monitoring
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents