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Randomized Controlled Trial
. 2010 Feb;167(2):151-9.
doi: 10.1176/appi.ajp.2009.09050691. Epub 2009 Dec 15.

A randomized trial of medical care management for community mental health settings: the Primary Care Access, Referral, and Evaluation (PCARE) study

Benjamin G Druss  1 , Silke A von Esenwein, Michael T Compton, Kimberly J Rask, Liping Zhao, Ruth M Parker
Affiliations
Randomized Controlled Trial

A randomized trial of medical care management for community mental health settings: the Primary Care Access, Referral, and Evaluation (PCARE) study

Benjamin G Druss et al. Am J Psychiatry. 2010 Feb.

Abstract

Objective: Poor quality of healthcare contributes to impaired health and excess mortality in individuals with severe mental disorders. The authors tested a population-based medical care management intervention designed to improve primary medical care in community mental health settings.

Method: A total of 407 subjects with severe mental illness at an urban community mental health center were randomly assigned to either the medical care management intervention or usual care. For individuals in the intervention group, care managers provided communication and advocacy with medical providers, health education, and support in overcoming system-level fragmentation and barriers to primary medical care.

Results: At a 12-month follow-up evaluation, the intervention group received an average of 58.7% of recommended preventive services compared with a rate of 21.8% in the usual care group. They also received a significantly higher proportion of evidence-based services for cardiometabolic conditions (34.9% versus 27.7%) and were more likely to have a primary care provider (71.2% versus 51.9%). The intervention group showed significant improvement on the SF-36 mental component summary (8.0% [versus a 1.1% decline in the usual care group]) and a nonsignificant improvement on the SF-36 physical component summary. Among subjects with available laboratory data, scores on the Framingham Cardiovascular Risk Index were significantly better in the intervention group (6.9%) than the usual care group (9.8%).

Conclusions: Medical care management was associated with significant improvements in the quality and outcomes of primary care. These findings suggest that care management is a promising approach for improving medical care for patients treated in community mental health settings.

Trial registration: ClinicalTrials.gov NCT00183313.

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Conflict of interest statement

None of the other authors report any potential conflicts of interest.

Figures

Figure 1
Figure 1
Study Flow Chart
Figure 2
Figure 2
Change in Receipt of Indicated Preventive Services
See this image and copyright information in PMC

Comment in

References

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