Improving Primary Care in Patients With Mental Disorders

Study Overview
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Brief Summary
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This study will determine the effectiveness of medical case management in improving the medical care of people with mental disorders or substance abuse problems.

Detailed Description
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Poor quality of care may contribute to impaired health status and increased mortality in individuals with serious mental disorders and substance abuse problems; interventions designed to improve medical care for this population need to be developed. This study will develop a population-based medical case management model for improving the primary medical care of patients at an inner city community mental health center. This study will last 2 years. Participants will be randomly assigned to receive medical case management or standard of care (typically drug and behavioral therapy) for 2 years. Participants in the case management group will receive help in overcoming barriers to receiving primary care. Participants will also undergo 5 interviews over the 2-year study duration, and have annual chart reviews. Results of the interviews will be used to assess quality of primary care, service use, health outcomes, psychiatric symptoms, and substance use.

Official Title
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Improving Primary Care in Patients With Mental Disorders

Conditions
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Mental Disorders

Intervention / Treatment
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* Behavioral: Nurse case management
* Behavioral: Usual care


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of mental illness or substance abuse Patient at Florida Hall (Grady Health Systems) Exclusion Criteria: Current use of medical case management

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 1<br>Participants will receive nurse case management intervention | Behavioral: Nurse case management<br>* Nurse case management is a population-based medical case management program to improve the delivery of primary medical care to patients with serious mental illness in a Community Mental Health Center (CMHC) in Atlanta GA. The treatment draws on elements from the primary care, nursing case management, chronic disease, health behavior change literature, and from the study team's experience in integrating primary care services for patients with serious mental illnesses.<br>|
| Active Comparator: 2<br>Participants will receive usual care | Behavioral: Usual care<br>* Usual care includes standard mental health services.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Quality of primary medical care |  | Measured over 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Health status |  | Measured over 2 years | 
| Psychiatric symptoms |  | 2004-2009 | 
| Costs |  | 2004-2009 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Mental Health, Primary health care, Case management