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School and Program Updates

School and Program Updates

UNC Studies Care of People with Severe Mental Illness in Medical Homes

Primary care-based medical homes are becoming more prevalent among people with chronic illnesses. Little is known about how these models affect patterns of care for people with severe mental illness who typically receive a significant amount of their care from mental health specialists.

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[Photo: Enrollment in a medical home was associated with substantial changes in patterns of care among persons with severe mental illness. These changes were associated with only a modest set of incentives, suggesting that medical homes can have large multiplier effects in primary care of persons with severe mental illness. Photo by Mr. Sean Drellinger.]

Dr. Marisa Domino, professor of health policy and management at UNC Gillings School of Global Public Health, led a study to examine whether enrollment in a primary care medical home alters the patterns of care for Medicaid enrollees with severe mental illness. The study was published May 1 in the journal Psychiatric Services.

Dr. Domino and colleagues analyzed medication adherence, outpatient and emergency department visits, and screening services used by adult Medicaid enrollees with diagnoses of schizophrenia (N=7,228), bipolar disorder (N=13,406), or major depression (N=45,000) as recorded in North Carolina Medicaid claims from 2004 to 2007. They found that medical home enrollees had greater use of both primary and specialty mental health care, better medication adherence and reduced use of the emergency department. Better rates of preventive lipid and cancer screening were found only for persons with major depression.

Enrollment in a medical home was associated with substantial changes in patterns of care among persons with severe mental illness. These changes were associated with only a modest set of incentives, suggesting that medical homes can have large multiplier effects in primary care of persons with severe mental illness.