Enhanced primary care for people with mental illness could improve service use and quality

April 19, 2021

People with serious mental illness (SMI) live with conditions that can significantly impair their function, and many are at greater risk for additional chronic health conditions. The care they receive, however, is often low quality and difficult to access, leading to more frequent hospital visits, higher medical costs and, ultimately, a lower life expectancy.

While several models integrate behavioral and physical health needs when caring for these patients, researchers at UNC believe that a new enhanced primary care model shows promise to improve the quality of health services provided to people with SMI and reduce their hospital visits.

Published in the Journal of General Internal Medicine, health policy and management doctoral student Lexie Grove, MPSH, alumnus Alex Gertner, PhD (’20), and alumnae Karen Swietek, PhD (’18) and Ching-Ching Claire Lin, PhD (’17), co-led a study to examine the effect that enhanced services provided by UNC WakeBrook Primary Care in Wake County, North Carolina, had on use of service by people with SMI. The study team also included doctoral student Tyler Malone, MS, and Professor Marisa Domino, PhD, from the Department of Health Policy and Management at the UNC Gillings School of Global Public Health.

Lexie Grove

“The enhanced primary care model at WakeBrook is innovative because it is specifically tailored to people with serious mental illness,” Grove explained. “Providers receive specialized training to care for people with SMI, and their visit times are longer than a typical primary care visit, which is intended to help them build trust with patients. This study came about because the WakeBrook team wanted to understand whether the model could move the needle on patients’ health care use patterns and preventive service receipt.”

The WakeBrook Primary Care model was developed by study co-author Beat Steiner, MD, MPH, and other clinicians at UNC. The model trains providers to work with people with SMI, gives them more time to address patients’ needs and supports integration with psychiatric care.

The team reviewed North Carolina Medicaid claims data from patients with schizophrenia or schizoaffective disorder who newly received primary care at WakeBrook and compared them to a control group of new primary care users in Mecklenburg County, which does not have an enhanced primary care clinic. They measured patient use of several services, including the total number of primary care visits, outpatient psychiatric visits, inpatient psychiatric and non-psychiatric admissions, and emergency department (ED) visits in an 18-month follow-up period.

Patients with SMI who used enhanced primary care services were more likely to use certain preventive screenings, including glucose and HIV, than in traditional primary care. They also had fewer non-psychiatric inpatient hospitalizations and used primary care services more frequently, suggesting that an enhanced level of primary care may help patients with SMI become more engaged with providers who can better manage their health needs.

According to the study, for every ten people with SMI newly enrolled in enhanced primary care, three non-psychiatric inpatient stays could be avoided, and twelve additional primary care visits would take place over 18 months.

Study results indicate that the enhanced primary care model has the potential to lead to better outcomes for people with SMI and can be adopted by many team-based health care facilities, like patient-centered medical homes. While the study focused only on a limited demographic, the findings are key in helping public health experts and health care providers learn which medical interventions are worth investing in to provide effective care for people with SMI.

Dr. Alex Gertner

“Healthcare systems can be challenging, frightening and even dangerous places for people with SMI,” said Gertner. “We have a responsibility to adapt systems to the needs of the communities we serve. We’re fortunate that UNC clinicians have worked to develop systems and practices that respond to the need and preferences of people with SMI. The next step is to work on replicating this model and ensuring payment policies can support innovations that improve care for people with SMI.”

The team is currently using electronic health record data to conduct a complementary analysis of the clinical outcomes associated with the WakeBrook model of enhanced primary care.

Additional study team members included Neepa Ray, MS; David L. Rosen, MD, PhD; Theodore R. Zarzar, MD; and Brian Sheitman, MD.

Contact the UNC Gillings School of Global Public Health communications team at sphcomm@unc.edu.