A Primary Care Model to Enhance Care for the Seriously Mentally Ill

What’s New in Psychology?

A Primary Care Model to Enhance Care for the Seriously Mentally Ill  

Jim Windell


           There are more than 14 million American adults living with a serious mental illness. Serious mental illness is defined as a mental, behavioral or emotional disorder resulting in serious functional impairment. Patients with serious mental illness have been shown to have lower quality treatment for these conditions and poor cardiometabolic outcomes, both of which contribute to high-cost medical care down the line. Obviously, this presents a major challenge for the U.S. healthcare system.

           Cardiometabolic health conditions – such as high blood pressure, diabetes and heart attacks – are more common in adults with serious mental illness than the general population. But is there a type of primary care that could reduce cardiometabolic heath conditions?

           Over the past several years, the Department of Family Medicine and the Department of Psychiatry in the University of North Carolina’s School of Medicine have been working together to spearhead the development of a new “enhanced primary care” model to provide better primary care for patients who have severe mental illnesses. A new study, recently published in Journal of Clinical Psychiatry, suggests that a new primary care model proves effective for patients with severe mental illness.

           For this new study, researchers started by comparing 234 patients with severe mental illness receiving enhanced primary care at WakeBrook to 4,934 patients with serious mental illness receiving usual primary care using electronic health data.

           The clinic at WakeBrook is especially unique in that it is adapted to care for the physical health needs of people with severe mental illnesses. The clinic’s enhanced primary care model involves training primary care providers to work with patients with severe mental illness, delivering integrated care with behavioral health providers, and providing longer visits to address patients’ needs. The study results indicate that the use of the new primary care model has produced astounding results.

           A previous analysis by Alex K. Gertner, M.D., Ph.D., a psychiatry resident at UNC Hospitals, and Beat Steiner, M.D., M.P.H., professor in the Department of Family Medicine, and others found that enhanced primary care reduced hospitalizations for physical health needs among people with serious mental illness compared to usual primary care.

           According to Gertner, lead author of the study, “What distinguishes enhanced primary care from many prior studies is that this model is specifically adapted to meet the needs of people with severe mental illness. Many previous studies that have tested the effect of primary care on people with severe mental illness have not achieved improvements in clinical outcomes, which makes these findings exciting.”

           The findings, as reported in this new study, show that patients who received care at WakeBrook had reductions in blood pressure and hemoglobin A1c compared to those at other primary care clinics. The reductions in hemoglobin A1c and blood pressure were clinically significant. The size of the decrease in hemoglobin A1c was comparable to what can be accomplished by starting a patient on insulin, and the size of the decrease in blood pressure was comparable to what can be accomplished by a moderate reduction in weight or an increase in physical activity.

           Researchers were also able to establish that enhanced primary care increased screening patients for hemoglobin A1c, low-density lipoprotein aka “bad cholesterol,” and blood pressure compared to usual primary care.

           “On average, people with severe mental illness die twenty-five years earlier than the general population, with most of these deaths caused by chronic physical conditions,” said Steiner, who was also involved in the new study. “Therefore, developing and implementing models for the physical health needs of our patients is a critical healthcare and public health priority.”

           To read the full report, find it with this reference:

Gertner, A. K., Grove, L. R., Swietek, K. E., Lin, C. C. C., Ray, N., Malone, T. L., ... & Steiner, B. D. (2023). Enhanced Primary Care for People With Serious Mental Illness: A Propensity Weighted Cohort Study. The Journal of Clinical Psychiatry, 84(3), 46511.


Share this post:

Comments on "A Primary Care Model to Enhance Care for the Seriously Mentally Ill"

Comments 0-5 of 0

Please login to comment