Journal Article Annotations
2016, 4th Quarter
Annotations by Lydia Chwastiak MD, MPH, FAPM and Oliver Freudenreich MD, FAPM
The finding: This reports the findings from the evaluation of the very large SAMHSA-funded national demonstration program to integrate primary care into Community Mental Health Organizations (PBHCI), which funded more than 100 CMHC to partner with FQHC partners between 2008 and the present. This is the first report of clinical outcomes from these programs to integrate care for clients with SMI, and demonstrated significant improvement in cholesterol, in particular LDL cholesterol, among clients receiving this integrated care.
Strengths: The study included a large sample from these real-world settings, in which care was provided by clinical staff (increasing the generalizability of the findings).
Weaknesses: The SAMHSA PBHCI program was a demonstration program, so organizations were funded to provide care. This was not a clinical trial, so there was no control group as part of the program. The evaluation team drew data from local comparable clinics to provide a comparison group. In addition, while the improvement in LDL cholesterol seems to be a clinically meaningful change and is encouraging, the heterogeneity across the sites with respect to the services provided make it difficult to specify the effective components of the integrated care interventions.
Relevance: This demonstrates that it is possible to improve (some) medical outcomes for patients with SMI through integrated care based at CMHCs—so supports ongoing initiatives to continue this work.
The finding: This is a second report from the SAMHSA PBHCI program, which describes cost savings associated with integrating primary care at CMHC for patients with SMI. These analyses demonstrate some reduction in inpatient costs (reduction in proportion of clients with an inpatient hospital admission and a trend for reduction in costs).
Strengths: As above, the study included a large sample from real-world CMHC settings, in which care was provided by clinical staff (increasing the generalizability of the findings).
Weaknesses: The SAMHSA PBHCI program was a demonstration program, so organizations were funded to provide care. This was not a clinical trial, so there was no control group as part of the program. The evaluation team drew data from local comparable clinics to provide a comparison group.
Relevance: This demonstrates that integrating care for patients with SMI may be associated with reduced medical costs.
The finding: This systematic review of 15 studies of self-management of medical illness among patients with SMI suggests that these interventions have clinical effectiveness (with respect to improving self-management), but that more attention needs to be paid to implementation factors in order to increase potential for uptake.
Strengths: Rigorous methods were employed.
Weaknesses: There was substantial variability across these studies. It would be important to demonstrate improvement in clinical outcomes as well as in self-management behaviors.
Relevance: Numerous studies have demonstrated the feasibility and acceptability of self-management interventions, but the authors of this systematic review identify the critical need to consider implementation issues.