Enhanced Primary Care for People With Serious Mental Illness: A Propensity Weighted Cohort Study

Alex K. Gertner, MD, PhD; Lexie R. Grove, PhD, MSPH; Karen E. Swietek, PhD; Ching-Ching Claire Lin, PhD; Neepa Ray, MS; Tyler L. Malone, MS; David L. Rosen, MD, PhD; Theodore R. Zarzar, MD; Marisa Elena Domino, PhD; Beat D. Steiner, MD, MPH

J Clin Psychiatry 2023;84(3):22m14496

ABSTRACT

Objective: People with serious mental illness (SMI) have high rates of cardiometabolic illness, receive low quality care, and experience poor outcomes. Nevertheless, studies of existing integrated care models have not consistently shown improvements in cardiometabolic health for people with SMI. This study assessed the effect of a novel model of enhanced primary care for people with SMI on cardiometabolic outcomes. Enhanced primary care is a model of integrated care wherein comprehensive primary care delivery is adapted to the needs of people with SMI in coordination with behavioral care.

Methods: We conducted a propensity-weighted cohort study comparing 234 patients with SMI receiving enhanced primary care to 4,934 patients with SMI receiving usual primary care using electronic health data from a large academic medical system covering the years 2014–2018. The propensity-weighted models controlled for baseline differences in outcome measures and patient characteristics between groups.

Results: Compared to usual primary care, enhanced primary care increased hemoglobin A_1c (HbA_1c) screening by 18 percentage points (95% confidence interval [CI], 10 to 25), low-density lipoprotein (LDL) screening by 16 percentage points (CI, 8.8 to 24), and blood pressure screening by 7.8 percentage points (CI, 5.8 to 9.9). Enhanced primary care reduced HbA_1c by 0.27 percentage points (CI, −0.47 to −0.060) and systolic blood pressure by 3.9 mm Hg (CI, −5.2 to −2.5) compared to usual primary care. We did not find evidence that enhanced primary care consistently affected glucose screening, LDL values, or diastolic blood pressure.

Conclusions: Enhanced primary care can achieve clinically meaningful improvements in cardiometabolic health compared to usual primary care.

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