title: Nonpsychiatric Outpatient Care for Adults With Serious Mental Illness in California: Who Is Being Left Behind?
abstract: OBJECTIVE
  Although primary care is associated with better outcomes, many individuals with serious mental illness do not receive general medical services. This study examined patient-level factors associated with not having outpatient general medical visits among individuals with serious mental illness in California.
  
  
  METHODS
  The study analyzed administrative, pharmacy, and billing data for 56,895 Medicaid-enrolled adults with serious mental illness treated in community mental health clinics between October 1, 2010, and September 20, 2011. Poisson regression estimated independent associations between predictor variables and outpatient general medical visits.
  
  
  RESULTS
  One-third of participants (34%) had no outpatient general medical visits during the study. In multivariate analyses, younger adults (ages 18-27) were less likely than older groups to have such a visit (adjusted relative risk [ARR]=1.07 and 1.19, respectively, for ages 28-47 and 48-67). Women were more likely than men to have such a visit (ARR=1.29). Compared with whites, blacks were less likely to have an outpatient general medical visit (ARR=.93). Rural dwellers were less likely than urban dwellers to have such a visit (ARR=.64). Persons with drug or alcohol use disorders were less likely than those without such disorders to have an outpatient general medical visit (ARR=.95), and those with schizophrenia were less likely than those with any other psychiatric disorder examined to have such a visit.
  
  
  CONCLUSIONS
  Individuals with serious mental illness had low use of outpatient general medical services. Integrated care models are needed to engage these individuals and eliminate disparities in morbidity and mortality.
authors.affiliation: Dr. Garcia and Dr. Schillinger are with the Department of Medicine, Dr. Vittinghoff is with the Department of Epidemiology and Biostatistics, Ms. Creasman is with the Clinical and Translational Science Institute, and Dr. Mangurian is with the Department of Psychiatry, all at the University of California, San Francisco, School of Medicine (e-mail: maria.garcia@ucsf.edu ). Dr. Garcia, Dr. Schillinger, and Dr. Mangurian are also with Zuckerberg General Hospital, San Francisco. Dr. Knapp is with the Department of Psychiatry and Behavioral Sciences, University of California, Davis. Dr. Newcomer is with the Department of Integrated Medical Science, The Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Garcia
authors.affiliation: Dr. Garcia and Dr. Schillinger are with the Department of Medicine, Dr. Vittinghoff is with the Department of Epidemiology and Biostatistics, Ms. Creasman is with the Clinical and Translational Science Institute, and Dr. Mangurian is with the Department of Psychiatry, all at the University of California, San Francisco, School of Medicine (e-mail: maria.garcia@ucsf.edu ). Dr. Garcia, Dr. Schillinger, and Dr. Mangurian are also with Zuckerberg General Hospital, San Francisco. Dr. Knapp is with the Department of Psychiatry and Behavioral Sciences, University of California, Davis. Dr. Newcomer is with the Department of Integrated Medical Science, The Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton.
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
authors.affiliation: Dr. Garcia and Dr. Schillinger are with the Department of Medicine, Dr. Vittinghoff is with the Department of Epidemiology and Biostatistics, Ms. Creasman is with the Clinical and Translational Science Institute, and Dr. Mangurian is with the Department of Psychiatry, all at the University of California, San Francisco, School of Medicine (e-mail: maria.garcia@ucsf.edu ). Dr. Garcia, Dr. Schillinger, and Dr. Mangurian are also with Zuckerberg General Hospital, San Francisco. Dr. Knapp is with the Department of Psychiatry and Behavioral Sciences, University of California, Davis. Dr. Newcomer is with the Department of Integrated Medical Science, The Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton.
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.affiliation: Dr. Garcia and Dr. Schillinger are with the Department of Medicine, Dr. Vittinghoff is with the Department of Epidemiology and Biostatistics, Ms. Creasman is with the Clinical and Translational Science Institute, and Dr. Mangurian is with the Department of Psychiatry, all at the University of California, San Francisco, School of Medicine (e-mail: maria.garcia@ucsf.edu ). Dr. Garcia, Dr. Schillinger, and Dr. Mangurian are also with Zuckerberg General Hospital, San Francisco. Dr. Knapp is with the Department of Psychiatry and Behavioral Sciences, University of California, Davis. Dr. Newcomer is with the Department of Integrated Medical Science, The Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Creasman
authors.affiliation: Dr. Garcia and Dr. Schillinger are with the Department of Medicine, Dr. Vittinghoff is with the Department of Epidemiology and Biostatistics, Ms. Creasman is with the Clinical and Translational Science Institute, and Dr. Mangurian is with the Department of Psychiatry, all at the University of California, San Francisco, School of Medicine (e-mail: maria.garcia@ucsf.edu ). Dr. Garcia, Dr. Schillinger, and Dr. Mangurian are also with Zuckerberg General Hospital, San Francisco. Dr. Knapp is with the Department of Psychiatry and Behavioral Sciences, University of California, Davis. Dr. Newcomer is with the Department of Integrated Medical Science, The Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton.
authors.forename: Penelope
authors.initials: P
authors.lastname: Knapp
authors.affiliation: Dr. Garcia and Dr. Schillinger are with the Department of Medicine, Dr. Vittinghoff is with the Department of Epidemiology and Biostatistics, Ms. Creasman is with the Clinical and Translational Science Institute, and Dr. Mangurian is with the Department of Psychiatry, all at the University of California, San Francisco, School of Medicine (e-mail: maria.garcia@ucsf.edu ). Dr. Garcia, Dr. Schillinger, and Dr. Mangurian are also with Zuckerberg General Hospital, San Francisco. Dr. Knapp is with the Department of Psychiatry and Behavioral Sciences, University of California, Davis. Dr. Newcomer is with the Department of Integrated Medical Science, The Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton.
authors.forename: John W
authors.initials: JW
authors.lastname: Newcomer
authors.affiliation: Dr. Garcia and Dr. Schillinger are with the Department of Medicine, Dr. Vittinghoff is with the Department of Epidemiology and Biostatistics, Ms. Creasman is with the Clinical and Translational Science Institute, and Dr. Mangurian is with the Department of Psychiatry, all at the University of California, San Francisco, School of Medicine (e-mail: maria.garcia@ucsf.edu ). Dr. Garcia, Dr. Schillinger, and Dr. Mangurian are also with Zuckerberg General Hospital, San Francisco. Dr. Knapp is with the Department of Psychiatry and Behavioral Sciences, University of California, Davis. Dr. Newcomer is with the Department of Integrated Medical Science, The Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton.
authors.forename: Christina
authors.initials: C
authors.lastname: Mangurian
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D002140:California; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult
keywords: Medical morbidity and mortality in psychiatric patients; Outpatient treatment; Public health; Utilization patterns &amp