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Care managers increase primary care services for mentally ill

Clinical Question:
Do the services of care managers increase preventive and chronic disease management services for severely mentally ill adults who receve mental health services from a community mental health center?

Bottom Line:
Medical management by nurses can significantly improve the proportion of severely mentally ill patients who get the recommended preventive and chronic disease management services. Further study is required to demonstrate differences in morbidity and mortality outcomes. (LOE = 1b)

Reference:
Druss BG, von Esenwein SA, Compton MT, Rask KJ, Zhao L, Parker RM. A randomized trial of medical care management for community mental health settings: The Primary Care Access, Referral, and Evaluation (PCARE) Study. Am J Psychiatry 2010;167(2):151-159.  [PMID:20008945]

Study Design:
Randomized controlled trial (nonblinded)

Allocation:
Concealed

Setting:
Outpatient (specialty)

Synopsis:
This randomized controlled trial enrolled 407 patients with severe and persistent mental illness, with or without addiction disorders, who were receiving care in a community mental health center. Participants reflected the demographics of the health center: 78% African American with a median annual income of $3400. They were randomized to receive registered nurse care management or usual care for 1 year. Patients were interviewed (by interviewers masked to allocation) at 6 months and 12 months. All medical records were reviewed. The intervention consisted of motivational interviewing; serving as patient advocate, including accompaniment for office visits if deemed necessary; facilitation of communication between medical and mental health providers; assistance with enrollment in entitlement programs; provision of transportation tokens; and troubleshooting in other ways, such as child care arrangements if needed. The number of patients per care manager was not provided. After 1 year the aggregate proportion of patients who had received any of 25 US Preventive Health Services Task Force recommended services was 59% in the care management group versus 22% in the usual care group (P < .001). The proportion who identified a source of primary care and had at least 1 documented visit was 71% versus 52% (P = .001). The proportion with newly diagnosed medical conditions during the study period was 12% versus 2% (P = .005). The intervention group showed significant improvement on the mental component of the SF-36 (P = .008), but not the physical component. An aggregate score for indicated services for patients was cardiometabolic conditions (diabetes, hyperlipidemia, and hypertension) was 35% versus 28% (P = .03).

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