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Mental Health Provider Perspectives Regarding Integrated Medical Care for Patients with Serious Mental Illness

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Abstract

Integrated care for medical conditions is essential for persons with serious mental illness (SMI). This qualitative study describes mental health provider perspectives regarding barriers and facilitators of integrated care for patients with SMI. We interviewed providers from a national sample of Veterans Health Administration facilities that scored in the top or bottom percentile in medical care quality. Providers from high-performing sites reported substantial in-person contacts with general medical providers, while providers from low-performing sites reported stigma and limited communication with medical providers as major concerns. Interventions to improve mental health and medical provider communication may facilitate integrated care for persons with SMI.

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References

  • Asch, S. M., McGlynn, E. A., Hogan, M. M., et al. (2004). Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample. Annals of Internal Medicine, 141, 938–945.

    PubMed  Google Scholar 

  • Bodenheimer, T., Wagner, E. H., & Grumbach, K. (2002). Improving primary care for patients with chronic illness: the chronic care model, Part 2. Journal of American Medical Association, 288, 1909–1914.

    Article  Google Scholar 

  • Brown, R. A., & Ramsey, S. E. (2000). Addressing comorbid depressive symptomatology in alcohol treatment. Professional Psychology: Research and Practice, 31, 418–422.

    Article  Google Scholar 

  • Charmaz, K. (2006). Constructing Grounded Theory: A Practical Guide Through Qualitative Analysis. London: Sage Publications.

    Google Scholar 

  • Colton, C. W., & Manderscheid, R. W. (2006). Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Prevention of Chronic Disease, 3, A42.

    Google Scholar 

  • Department of Veterans Affairs, Veterans Health Administration: Evaluation of Services for Seriously Mentally Ill Patients in the Veterans Health Administration of the Department of Veterans Affairs. Statement of Work. Office of Policy, Planning, and Preparedness Department of Veterans Affairs, April 2005.

  • Desai, M. M., Rosenheck, R. A., Druss, B. G., et al. (2002). Mental disorders and quality of diabetes care in the VHA. American Journal of Psychiatry, 159, 1584–1590.

    Article  PubMed  Google Scholar 

  • Druss, B. G., & Bornemann, T. H. (2010). Improving health and health care for persons with serious mental illness: the window for US federal policy change. Journal of American Medical Association, 303, 1972–1973.

    Article  CAS  Google Scholar 

  • Druss, B. G., & Rohrbaugh, R. M. (2000). Integrated medical care for patients with serious psychiatric illness: A randomized trial. Archives of General Psychiatry, 58, 861–868.

    Article  Google Scholar 

  • Druss, B. G., & Rosenheck, R. A. (2000). Locus of mental health treatment in an integrated service system. Psychiatric Services, 51, 890–892.

    Article  PubMed  CAS  Google Scholar 

  • Druss, B. G., Bradford, D. W., Rosenheck, R. A., et al. (2000). Mental disorders and use of cardiovascular procedures after myocardial infarction. Journal of American Medical Association, 283, 506–511.

    Article  CAS  Google Scholar 

  • Druss, B. G., Rosenheck, R. A., Desai, M. M., & Perlin, J. B. (2002). Quality of preventative medical care for patients with mental disorders. Medical Care, 40, 129–136.

    Article  PubMed  Google Scholar 

  • Druss, B. G., von Esenwein, S. A., Compton, M. T., et al. (2010). A randomized trial of medical care management for community mental health settings: The primary care access, referral, and evaluation (PCARE) study. American Journal of Psychiatry, 167, 151–159.

    Article  PubMed  Google Scholar 

  • Greenberg, G. A., Rosenheck, R. A., & Fontana, A. (2003). Continuity of care and clinical effectiveness: Treatment of posttraumatic stress disorder in the Department of Veterans Affairs. Journal of Behavioral Health Services Research, 30, 202–214.

    Article  PubMed  Google Scholar 

  • Hogan, M. F. (2003). The President's New Freedom Commission: recommendations to transform mental health care in America. Psychiatric Services, 54, 1467–1474.

    Article  PubMed  Google Scholar 

  • Horvitz-Lennon, M., Kilbourne, A. M., & Pincus, H. A. (2006). From silos to bridges: meeting the general health care needs of adults with severe mental illnesses. Health Affairs, 25, 659–669.

    Article  PubMed  Google Scholar 

  • Institute of Medicine. (2005). Improving quality of health care for mental and substance use conditions. Washington DC: National Academy Press.

    Google Scholar 

  • Katon, W. J., Lin, E. H., Von Korff, M., Ciechanowski, P., Ludman, E. J., Young, B., et al. (2010). Collaborative care for patients with depression and chronic illnesses. The New England Journal of Medicine, 363, 2611–2620.

    Article  PubMed  CAS  Google Scholar 

  • Kilbourne, A. M., Pirraglia, P., Lai, Z., et al. Quality of General Medical Care in Patients with Serious Mental Illness: Does Co-Location of Services Matter? Psychiatric Services (in press, 2011).

  • Kilbourne, A. M., McCarthy, J. F., Post, E. P., et al. (2006). Access to and satisfaction with care comparing patients with and without serious mental illness. International Journal of Psychiatry in Medicine, 36, 383–399.

    Article  PubMed  Google Scholar 

  • Kilbourne, A. M., Irmiter, C., Capobianco, J., Reynolds, K., Milner, K., Barry, K., et al. (2008a). Improving integrated general medical and mental health services in community-based practices. Administration and Policy in Mental Health, 35, 337–345.

    Article  PubMed  Google Scholar 

  • Kilbourne, A. M., Post, E. P., Nossek, A., Drill, L., Cooley, S., & Bauer, M. S. (2008b). Improving medical and psychiatric outcomes among individuals with bipolar disorder: A randomized controlled trial. Psychiatric Services, 59, 760–768.

    Article  PubMed  Google Scholar 

  • Kilbourne, A. M., Welsh, D., McCarthy, J. F., et al. (2008c). Quality of care for cardiovascular disease-related conditions in patients with and without mental disorders. Journal of General Internal Medicine, 23, 1628–1633.

    Article  PubMed  Google Scholar 

  • Kilbourne, A. M., Ignacio, R. V., Kim, H. M., & Blow, F. C. (2009). Datapoints: Are VA patients with serious mental illness dying younger? Psychiatric Services, 60, 589.

    Article  PubMed  Google Scholar 

  • Kilbourne, A. M., Hermann, R., McCarthy, J. F., et al. (2010). Financial incentives and accountability for integrated medical care in VA mental health programs. Psychiatric Services, 61, 38–44.

    Article  PubMed  Google Scholar 

  • Koran, L. M., Sox, H. C., Jr., Marton, K. I., et al. (1989). Medical evaluation of psychiatric patients. I. Results in a state mental health system. Archives of General Psychiatry, 46, 733–740.

    Article  PubMed  CAS  Google Scholar 

  • Kupfer, D. J. (2005). The increasing medical burden in bipolar disorder. Journal of American Medical Association, 293, 2528–2530.

    Article  CAS  Google Scholar 

  • Levinson Miller, C., Druss, B. G., Dombrowski, E. A., et al. (2003). Barriers to primary medical care among patients at a community mental health center. Psychiatric Services, 54, 1158–1160.

    Article  PubMed  Google Scholar 

  • McGuire, J., Gelberg, L., Blue-Howells, J., & Rosenheck, R. A. (2009). Access to primary care for homeless Veterans with serious mental illness or substance abuse: a follow-up evaluation of co-located primary care and homeless social services. Administration and Policy in Policy in Mental Health, 36, 255–264.

    Article  Google Scholar 

  • Meterko, M., Mohr, D. C., & Young, G. J. (2004). Teamwork culture and patient satisfaction in hospitals. Medical Care, 42, 492–498.

    Article  PubMed  Google Scholar 

  • Morden, N. E., Berke, E. M., Welsh, D. E., et al. (2010). Quality of care for cardiometabolic disease: associations with mental disorder and rurality. Medical Care, 48, 72–78.

    Article  PubMed  Google Scholar 

  • Morse, J. M. (2003). Biasphobia. Qualitative Health Research, 13(7), 891–892.

    Article  PubMed  Google Scholar 

  • Mueser, K. T., Drake, R. E., & Miles, K. M. (1997). The course and treatment of substance use disorder in persons with severe mental illness. National Institute of Drug Abuse Research Monograph: Treatment and HIV-related Issues, 172, 86–109.

    CAS  Google Scholar 

  • Murray, C. J., & Lopez, A. D. (1996). Evidence-based health policy—lessons from the global burden of disease study. Science, 274, 740–743.

    Article  PubMed  CAS  Google Scholar 

  • Newcomer, J. W. (2005). Second-generation (atypical) antipsychotics and metabolic effects: A comprehensive literature review. Central Nervous System Drugs, 19(Suppl 1), 1–93.

    CAS  Google Scholar 

  • Post, E. P., & Van Stone, W. W. (2008). Veterans Health Administration primary care-mental health integration initiative. North Carolina Medical Journal, 69, 49–52.

    PubMed  Google Scholar 

  • Rosenheck, R. A., & Cicchetti, D. (1998). A mental health program report card: A multidimensional approach to performance monitoring in public sector programs. Community Mental Health Journal, 34, 85–106.

    Article  PubMed  CAS  Google Scholar 

  • Schaefer, J. A., Cronkite, R., & Ingudomnukul, E. (2004). Assessing continuity of care practices in substance use disorder treatment programs. Journal of Studies on Alcohol, 65, 513–520.

    PubMed  Google Scholar 

  • Shortell, S. M., Zazzali, J. L., Burns, L. R., et al. (2001). Implementing evidence-based medicine: The role of market pressures, compensation incentives, and culture in physician organizations. Medical Care, 39, I62–I78.

    PubMed  CAS  Google Scholar 

  • Tracy, S. W., Trafton, J. A., Humphreys, K. (2004). The Department of Veterans Affairs Substance Abuse Treatment System: Results of the 2004 Drug and Alcohol Program Survey. Palo Alto: VA Program Evaluation and Resource Center and Center for Health Care Evaluation 2004. http://www.chce.research.med.va.gov.

  • VHA Office of Quality and Performance. FY 2007 Executive Career Field. Network Director Performance Measurement System and JCAHO Hospital Core Measures Technical Manual. January 5, 2007.

  • Wrobel, J. S., Charns, M. P., Diehr, P., et al. (2003). The relationship between provider coordination and diabetes-related foot outcomes. Diabetes Care, 26, 3042–3047.

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service and the National Institute of Mental Health. The views expressed in this article are those of the authors and do not necessarily represent the views of the VA.

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Authors and Affiliations

  1. VA Ann Arbor Center for Clinical Management Research, 2215 Fuller Road, Ann Arbor, MI, 48105, USA

    Amy M. Kilbourne

  2. Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA

    Amy M. Kilbourne

  3. VA Pittsburgh Center for Health Equity Research and Promotion, Pittsburgh, PA, USA

    Devra E. Greenwald

  4. VA Boston Center for Organization, Management, and Leadership Research (COLMR), Boston, MA, USA

    Mark S. Bauer & Martin P. Charns

  5. Harvard Medical School, Cambridge, MA, USA

    Mark S. Bauer

  6. Boston University School of Public Health, Boston, MA, USA

    Martin P. Charns

  7. VA Greater Los Angeles HSR&D Center of Excellence for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, Sepulveda, Los Angeles, CA, USA

    Elizabeth M. Yano

  8. Department of Health Services, UCLA School of Public Health, Los Angeles, CA, USA

    Elizabeth M. Yano

Authors
  1. Amy M. Kilbourne
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  2. Devra E. Greenwald
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  3. Mark S. Bauer
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  4. Martin P. Charns
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  5. Elizabeth M. Yano
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Corresponding author

Correspondence to Amy M. Kilbourne.

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Kilbourne, A.M., Greenwald, D.E., Bauer, M.S. et al. Mental Health Provider Perspectives Regarding Integrated Medical Care for Patients with Serious Mental Illness. Adm Policy Ment Health 39, 448–457 (2012). https://doi.org/10.1007/s10488-011-0365-9

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  • DOI: https://doi.org/10.1007/s10488-011-0365-9

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