CRANIUM: a quasi-experimental study to improve metabolic screening and HIV testing in community mental health clinics compared to usual care
| Autor: | Alison R. Hwong, D. Nyasha Chagwedera, Marilyn Thomas, Grace Niu, Judy Quan, Eric Vittinghoff, Dean Schillinger, John W. Newcomer, Ana Gonzalez, Susan Essock, Christina Mangurian |
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| Rok vydání: | 2021 |
| Předmět: |
Comparative Effectiveness Research
Glycated Hemoglobin A Clinical Trials and Supportive Activities Clinical Sciences HIV Infections HIV Testing Clinical Research Behavioral and Social Science Psychology Humans Psychiatry Glycated Hemoglobin Prevention Diabetes Skull Integrated care Health Services Serious mental illness Lipids Psychiatry and Mental health Good Health and Well Being Mental Health Collaborative care Public Health and Health Services Infection Health care disparities |
| Zdroj: | BMC psychiatry, vol 22, iss 1 |
| ISSN: | 1471-244X |
| Popis: | Background Individuals with serious mental illness often do not receive guideline-concordant metabolic screening and human immunodeficiency virus (HIV) testing, contributing to increased morbidity and premature mortality. This study evaluates the effectiveness of CRANIUM (Cardiometabolic Risk Assessment and treatment through a Novel Integration model for Underserved populations with Mental illness), an intervention to increase metabolic screening and HIV testing among patients with serious mental illness in a community mental health clinic compared to usual care. Methods The study used a quasi-experimental design, prospectively comparing a preventive care screening intervention at one community mental health clinic (n = 536 patients) to usual care at the remaining clinics within an urban behavioural health system (n = 4,847 patients). Psychiatrists at the intervention site received training in preventive health screening and had access to a primary care consultant, screening and treatment algorithms, patient registries, and a peer support specialist. Outcomes were the change in screening rates of A1c, lipid, and HIV testing post-intervention at the intervention site compared to usual care sites. Results Rates of lipid screening and HIV testing increased significantly at the intervention site compared to usual care, with and without multivariable adjustment [Lipid: aOR 1.90, 95% CI 1.32–2.75, P = .001; HIV: aOR 23.42, 95% CI 5.94–92.41, P P = .09). Conclusions This low-cost, reverse integrated care model targeting community psychiatrist practices had modest effects on increasing preventive care screenings, with the biggest effect seen for HIV testing rates. Additional incentives and structural supports may be needed to further promote screening practices for individuals with serious mental illness. |
| Databáze: | OpenAIRE |
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