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June 11, 2019

Why medical care should come to mental health clinics (and not the other way around), according to a new study

Daily Briefing

    Health care providers are continuously working to find efficient ways to treat some of the United States most vulnerable populations, and a new study suggests individuals with severe mental health conditions saw overall improvements to their health under a new treatment model called "reverse co-location."

    3 surprising trends about your patients' co-location preferences

    Under the reverse co-location model, local mental health clinics serve as the "medical home" for patients with severe mental health conditions, providing both psychobehavioral and primary care, MedPage Today reports.

    Study details

    For the study, Karen Sautter Errichetti of Health Resources in Action, who co-authored the study with M. Marlen Ramirez and Michelle Brodesky, set out to determine whether the model would lead patients diagnosed with bipolar disorder, depression, or schizophrenia to see overall improvements in their health and quality of life.

    To test the model, they conducted a randomized controlled trial at four community behavioral health clinics in south Texas. The trial involved 416 patients ages 18 years of age or older who had been diagnosed with a serious mental condition and had one or more chronic health conditions, such as diabetes, hypercholesterolemia, hypertension, or obesity. About 55% of the participants were women, and 93% were Hispanic.

    The researchers randomly assigned 249 of the patients to the reverse co-location treatment group, where they were intended to receive at least two visits with a primary care clinician and one visit with a dietitian or chronic care nurse over a span of 12 months. According to Errichetti, the treatment threshold was not a requirement, but the "vast majority" of participants completed the minimum number of visits.

    The remaining 167 patients were assigned to the control group, which received standard mental health care at the clinics.

    The researchers collected data on the participants' systolic blood pressure, HbA1c levels, diastolic blood pressure, body mass index, cholesterol, and PHQ-9 scores at the start of the study, as well as at six and 12 months into the study period. They presented their findings Monday at the AcademyHealth Annual Research Meeting.

    Receiving primary care at mental health facilities reduced patients' blood pressure

    The researchers found that, after 12 months, participants in the reverse co-location treatment group experienced larger reductions in systolic blood pressure and HbA1c when compared with patients in the control group. However, there were no statistically significant differences between the depression scores of each group, or between the groups' quality of life, the researchers found.

    Errichetti said the researchers are not sure what aspect of the reverse co-location treatment model contributed to the improvements in patients' systolic blood pressure and HbA1c levels since each patient might have received different care. For instance, she speculated that some patients might have been prescribed a blood pressure medication or a walking plan as part of their care plans.

    "We can't disentangle what may have made the difference for that individual patient. All we can say is that co-locating primary care in a local mental health authority setting improves systolic blood pressure and A1c," she said.


    Errichetti said it was "amazing" that the study detected an improvement in participants' systolic blood pressure. "To be able to move blood pressure within one year in a population with severe mental health challenges is striking and notable," she said. "That kind of finding is not common in the literature."

    Errichetti added that the study is the first to find improvement in systolic blood pressure at a community mental health clinic that treats a predominantly Hispanic population.

    However, the reduction measured in the study does not provide much insight into the "overall clinical impact" of the reverse co-location treatment model, MedPage Today reports. To measure its clinical impact, the researchers would have had to determine whether the reductions in systolic blood pressure or HbA1c moved a patient from hypertensive to pre-hypertensive or from diabetes to controlled diabetes, according to Errichetti, but the researchers "did not do those kinds of analyses," she said.

    Similarly, Errichetti said the study lacks generalizability because it was conducted among a population with a particular set of serious mental health conditions. However, she said the research has "the most broad applicability to communities that are similar to it."

    "This [study] is going to be tremendously helpful in thinking about how to work on issues like health equity … and it has the potential to reduce health care disparities," she said (Firth, MedPage Today, 6/7).

    June 13 webconference: Social Determinants 101

    To effectively manage your patients' care, it's not enough to ask care teams to address their social needs; you also must team up with community-based organizations to provide non-clinical support. Here's how.

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