title: Systematic Literature Review of General Health Care Interventions Within Programs of Assertive Community Treatment.
abstract: Assertive community treatment (ACT) is one of the few evidence-based practices for adults with severe mental illness. Interest has slowly waned for ACT implementation. Yet ACT remains an appealing services platform to achieve the triple aim of health care reform (improved health outcomes, reduced cost, and improved satisfaction) through integration of primary care and behavioral health services. This review highlights the evidence for ACT to improve general medical outcomes, reduce treatment costs, and increase access to treatment.
  
  
  
  Using a comprehensive list of relevant search terms, the authors performed a systematic literature database search for articles published through November 2015, resulting in ten articles for inclusion.
  
  
  
  No studies reported on clinical outcomes of general medical comorbidities or on mortality of ACT clients. Half of the studies reporting utilization (three of six) found a decrease in emergency room usage, and three of four studies identified an increase in outpatient primary care visits. Most studies found no increase in overall medical care costs. Of the few studies reporting on quality of life, most found mild to moderate improvements.
  
  
  
  To date, rigorous scientific examination of the effect of ACT on the general health of the populations it serves has not been undertaken. Given ACT's similarity to emerging chronic illness medical management models, the approach seems like a natural fit for improving general medical outcomes of persons with severe mental illnesses. More research is needed that investigates the current effect of ACT teams on general medical outcomes, treatment costs, and access to care.
authors.affiliation: Dr. Vanderlip is with the Department of Psychiatry and Medical Informatics and Ms. Schweikhard is with the Schusterman Library, both with the University of Oklahoma School of Community Medicine, Tulsa (e-mail: erik.vanderlip@gmail.com ). Dr. Henwood is with the School of Social Work, University of Southern California, Los Angeles. Dr. Hrouda is with the Department of Psychiatry, Case Western Reserve University, Cleveland. Dr. Meyer is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Monroe-DeVita is with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Studer is with the Minnesota Department of Human Services, St. Paul. Dr. Moser is with the Department of Psychiatry and Behavioral Sciences, University of North Carolina, Chapel Hill.
authors.forename: Erik R
authors.initials: ER
authors.lastname: Vanderlip
authors.affiliation: Dr. Vanderlip is with the Department of Psychiatry and Medical Informatics and Ms. Schweikhard is with the Schusterman Library, both with the University of Oklahoma School of Community Medicine, Tulsa (e-mail: erik.vanderlip@gmail.com ). Dr. Henwood is with the School of Social Work, University of Southern California, Los Angeles. Dr. Hrouda is with the Department of Psychiatry, Case Western Reserve University, Cleveland. Dr. Meyer is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Monroe-DeVita is with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Studer is with the Minnesota Department of Human Services, St. Paul. Dr. Moser is with the Department of Psychiatry and Behavioral Sciences, University of North Carolina, Chapel Hill.
authors.forename: Benjamin F
authors.initials: BF
authors.lastname: Henwood
authors.affiliation: Dr. Vanderlip is with the Department of Psychiatry and Medical Informatics and Ms. Schweikhard is with the Schusterman Library, both with the University of Oklahoma School of Community Medicine, Tulsa (e-mail: erik.vanderlip@gmail.com ). Dr. Henwood is with the School of Social Work, University of Southern California, Los Angeles. Dr. Hrouda is with the Department of Psychiatry, Case Western Reserve University, Cleveland. Dr. Meyer is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Monroe-DeVita is with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Studer is with the Minnesota Department of Human Services, St. Paul. Dr. Moser is with the Department of Psychiatry and Behavioral Sciences, University of North Carolina, Chapel Hill.
authors.forename: Debra R
authors.initials: DR
authors.lastname: Hrouda
authors.affiliation: Dr. Vanderlip is with the Department of Psychiatry and Medical Informatics and Ms. Schweikhard is with the Schusterman Library, both with the University of Oklahoma School of Community Medicine, Tulsa (e-mail: erik.vanderlip@gmail.com ). Dr. Henwood is with the School of Social Work, University of Southern California, Los Angeles. Dr. Hrouda is with the Department of Psychiatry, Case Western Reserve University, Cleveland. Dr. Meyer is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Monroe-DeVita is with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Studer is with the Minnesota Department of Human Services, St. Paul. Dr. Moser is with the Department of Psychiatry and Behavioral Sciences, University of North Carolina, Chapel Hill.
authors.forename: Piper S
authors.initials: PS
authors.lastname: Meyer
authors.affiliation: Dr. Vanderlip is with the Department of Psychiatry and Medical Informatics and Ms. Schweikhard is with the Schusterman Library, both with the University of Oklahoma School of Community Medicine, Tulsa (e-mail: erik.vanderlip@gmail.com ). Dr. Henwood is with the School of Social Work, University of Southern California, Los Angeles. Dr. Hrouda is with the Department of Psychiatry, Case Western Reserve University, Cleveland. Dr. Meyer is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Monroe-DeVita is with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Studer is with the Minnesota Department of Human Services, St. Paul. Dr. Moser is with the Department of Psychiatry and Behavioral Sciences, University of North Carolina, Chapel Hill.
authors.forename: Maria
authors.initials: M
authors.lastname: Monroe-DeVita
authors.affiliation: Dr. Vanderlip is with the Department of Psychiatry and Medical Informatics and Ms. Schweikhard is with the Schusterman Library, both with the University of Oklahoma School of Community Medicine, Tulsa (e-mail: erik.vanderlip@gmail.com ). Dr. Henwood is with the School of Social Work, University of Southern California, Los Angeles. Dr. Hrouda is with the Department of Psychiatry, Case Western Reserve University, Cleveland. Dr. Meyer is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Monroe-DeVita is with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Studer is with the Minnesota Department of Human Services, St. Paul. Dr. Moser is with the Department of Psychiatry and Behavioral Sciences, University of North Carolina, Chapel Hill.
authors.forename: Lynette M
authors.initials: LM
authors.lastname: Studer
authors.affiliation: Dr. Vanderlip is with the Department of Psychiatry and Medical Informatics and Ms. Schweikhard is with the Schusterman Library, both with the University of Oklahoma School of Community Medicine, Tulsa (e-mail: erik.vanderlip@gmail.com ). Dr. Henwood is with the School of Social Work, University of Southern California, Los Angeles. Dr. Hrouda is with the Department of Psychiatry, Case Western Reserve University, Cleveland. Dr. Meyer is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Monroe-DeVita is with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Studer is with the Minnesota Department of Human Services, St. Paul. Dr. Moser is with the Department of Psychiatry and Behavioral Sciences, University of North Carolina, Chapel Hill.
authors.forename: April J
authors.initials: AJ
authors.lastname: Schweikhard
authors.affiliation: Dr. Vanderlip is with the Department of Psychiatry and Medical Informatics and Ms. Schweikhard is with the Schusterman Library, both with the University of Oklahoma School of Community Medicine, Tulsa (e-mail: erik.vanderlip@gmail.com ). Dr. Henwood is with the School of Social Work, University of Southern California, Los Angeles. Dr. Hrouda is with the Department of Psychiatry, Case Western Reserve University, Cleveland. Dr. Meyer is with the Department of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul. Dr. Monroe-DeVita is with the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle. Dr. Studer is with the Minnesota Department of Human Services, St. Paul. Dr. Moser is with the Department of Psychiatry and Behavioral Sciences, University of North Carolina, Chapel Hill.
authors.forename: Lorna L
authors.initials: LL
authors.lastname: Moser
mesh_terms: D003156:Community Mental Health Services / Q000379:methods*; D006304:Health Status; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D011320:Primary Health Care / Q000379:methods*
keywords: Assertive community treatment; Community mental health services; Medical morbidity and mortality in psychiatric patients; Primary care