Approaches for coordinating primary and specialty care for persons with mental illness
ABSTRACT As managed care achieves greater penetration in the marketplace, increasing attention is being devoted to models of integration and coordination of behavioral health with general medical care. In considering strategies and models, attention must be given to the heterogeneity of patient populations and the fact that successful approaches with some patient populations may not be suitable for others. Six approaches are reviewed: mainstreaming, the liaison psychiatry/collaboration model, new practitioner models, independent carveouts, functionally integrated carveouts, and extended care models. Each offers potentials and limitations, but little outcome data are available. Managed care models are diverse and changing rapidly. Much depends on the commitments of managers and professionals to the collaborative process and the extent to which incentives are consistent with clinical goals. Despite the uncertain and changing environment, it is clear that primary care physicians will remain significant providers of mental health services if for no other reason than many patients will resist referral to specialty mental health providers.
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Article: Early psychosis and employment[Show abstract] [Hide abstract]
ABSTRACT: BACKGROUND: Employment may be an important factor in helping patients with early psychosis to recover rapidly and to avoid involvement in disability and welfare programs. METHODS: This study followed 351 patients with early psychoses, either primary psychoses or substance-induced psychoses, for two years to examine their patterns of competitive employment in relation to service use, psychosocial outcomes, and disability and welfare payments. RESULTS: Workers differed from non-workers at baseline and over two years. At baseline, they had better educational and employment histories, were more likely to have substance-induced psychoses rather than primary psychoses, were less likely to have drug dependence, had fewer negative symptoms, and had better psychosocial adjustment. Over two years, baseline psychosocial differences persisted, and the workers used fewer medications, mental health services, and disability or welfare payments. CONCLUSIONS: Employment predicts less service use and fewer disability claims among early psychosis patients. Thus, greater attention to supported employment early in the course of illness may reduce federal insurance costs and disability payments.Schizophrenia Research 03/2013; 146(1-3). DOI:10.1016/j.schres.2013.02.012 · 4.43 Impact Factor
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ABSTRACT: Background. Individuals with multimorbidity are vulnerable to poor quality of care due to issues related to care coordination. Ambulatory care sensitive hospitalizations (ACSHs) are widely accepted quality indicators because they can be avoided by timely, appropriate, and high-quality outpatient care. Objective. To examine the association between multimorbidity, mental illness, and ACSH. Study Design. We used a longitudinal panel design with data from multiple years (2000-2005) of Medicare Current Beneficiary Survey. Individuals were categorized into three groups: (1) multimorbidity with mental illness (MM/MI); (2) MM/no MI; (3) no MM. Multivariable logistic regressions were used to analyze the association between multimorbidity and ACSH. Results. Any ACSH rates varied from 10.8% in MM/MI group to 8.8% in MM/No MI group. Likelihood of any ACSH was higher among beneficiaries with MM/MI (AOR = 1.62; 95% CI = 1.14, 2.30) and MM (AOR = 1.54; 95% CI = 1.12, 2.11) compared to beneficiaries without multimorbidity. There was no statistically significant difference in likelihood of ACSH between MM/MI and MM/No MI groups. Conclusion. Multimorbidity (with or without MI) had an independent and significant association with any ACSH. However, presence of mental illness alone was not associated with poor quality of care as measured by ACSH.12/2012; 2012:823294. DOI:10.1155/2012/823294