Effect of Enhanced Primary Care for People with Serious Mental Illness on Service Use and Screening

J Gen Intern Med. 2021 Apr;36(4):970-977. doi: 10.1007/s11606-020-06429-2. Epub 2021 Jan 27.


Background: Strategies are needed to better address the physical health needs of people with serious mental illness (SMI). Enhanced primary care for people with SMI has the potential to improve care of people with SMI, but evidence is lacking.

Objective: To examine the effect of a novel enhanced primary care model for people with SMI on service use and screening.

Design: Using North Carolina Medicaid claims data, we performed a retrospective cohort analysis comparing healthcare use and screening receipt of people with SMI newly receiving enhanced primary care to people with SMI newly receiving usual primary care. We used inverse probability of treatment weighting to estimate average differences in outcomes between the treatment and comparison groups adjusting for observed baseline characteristics.

Participants: People with SMI newly receiving primary care in North Carolina.

Interventions: Enhanced primary care that includes features tailored for individuals with SMI.

Main measures: Outcome measures included outpatient visits, emergency department (ED) visits, inpatient stays and days, and recommended screenings 18 months after the initial primary care visit.

Key results: Compared to usual primary care, enhanced primary care was associated with an increase of 1.2 primary care visits (95% confidence interval [CI]: 0.31 to 2.1) in the 18 months after the initial visit and decreases of 0.33 non-psychiatric inpatient stays (CI: - 0.49 to - 0.16) and 3.0 non-psychiatric inpatient days (CI: - 5.3 to - 0.60). Enhanced primary care had no significant effect on psychiatric service and ED use. Enhanced primary care increased the probability of glucose and HIV screening, decreased the probability of lipid screening, and had no effect on hemoglobin A1c and colorectal cancer screening.

Conclusions: Enhanced primary care for people with SMI can increase receipt of some preventive screening and decrease use of non-psychiatric inpatient care compared to usual primary care.

Keywords: Medicaid; enhanced primary care; integrated care; schizophrenia; serious mental illness.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Humans
  • Medicaid
  • Mental Disorders* / diagnosis
  • Mental Disorders* / epidemiology
  • Mental Disorders* / therapy
  • North Carolina / epidemiology
  • Primary Health Care
  • Retrospective Studies
  • United States / epidemiology