The Primary Care Access Referral, and Evaluation (PCARE) Study: A Randomized Trial of Medical Care Management for Community Mental Health Settings

• Type of Material: Article
• Authors: Benjamin G Druss, Emory University; Silke Von Esenwein, Emory University; Michael T. Compton, Emory University; Kimberly J Rask, Emory University; Liping Zhao, Emory University; Ruth M Parker, Emory University
• Language: English
• Date: 2010-02
• Publisher: American Psychiatric Publishing
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © American Psychiatric Association
• Final Published Version (URL): http://ajp.psychiatryonline.org/article.aspx?articleID=102098
• Title of Journal or Parent Work: American Journal of Psychiatry
• ISSN: 0002-953X
• Volume: 167
• Issue: 2
• Start Page: 151
• End Page: 159
• Grant/Funding Information: The study was supported by NIMH R01MH070437 and K24MH075867.
• Research Categories: Health Sciences, Health Care Management; Health Sciences, Mental Health

Abstract

Objective Poor quality of health care contributes to impaired health and excess mortality in individuals with severe mental disorders. This study tests a population-based medical care management intervention to improve primary medical care in community mental health settings. Method A total of 407 subjects with severe mental illnesses at an urban community mental health center were randomized to either care management or usual care. For individuals in the intervention group, care managers provided communication and advocacy with medical providers, health education for patients, and support in overcoming system-level fragmentation and barriers to primary medical care. Results At 12-month follow-up, the intervention group received an average of 58.7% of recommended preventive services, compared to 21.8% in the usual care group (p<0.001). They received a significantly higher proportion of evidence-based services for cardiometabolic conditions (34.9% vs. 27.7%, p=0.03), and were more likely to have a primary care provider (71.2% vs. 51.9%, p=0.003). On the SF-36, the intervention group showed significant improvement on the Mental Component Summary score (8.0% improvement in intervention versus 1.1% decline in the control group, p=0.008) with a nonsigificant improvement on the Physical Component Summary score. Among subjects with available laboratory data, Framingham Cardiovascular Risk Scores were significantly lower (better) for intervention (6.9%) than control (9.8%) subjects (p=0.02). Conclusions Medical care management was associated with significant improvements in quality and outcomes of primary care. The findings suggest that care management is a promising approach for improving medical care for patients treated in community mental health settings. Clinicaltrials.gov identifier NCT00183313