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Diabetes Care ; 37(8): 2261-7, 2014 Aug.
Article de Anglais | MEDLINE | ID: mdl-24879839

RÉSUMÉ

OBJECTIVE: Persons with serious mental illness (SMI) may benefit from collocation of medical and mental health healthcare professionals and services in attending to their chronic comorbid medical conditions. We evaluated and compared glucose control and diabetes medication adherence among patients with SMI who received collocated care to those not receiving collocated care (which we call usual care). RESEARCH DESIGN AND METHODS: We performed a cross-sectional, observational cohort study of 363 veteran patients with type 2 diabetes and SMI who received care from one of three Veterans Affairs medical facilities: two sites that provided both collocated and usual care and one site that provided only usual care. Through a survey, laboratory tests, and medical records, we assessed patient characteristics, glucose control as measured by a current HbA1c, and adherence to diabetes medication as measured by the medication possession ration (MPR) and self-report. RESULTS: In the sample, the mean HbA1c was 7.4% (57 mmol/mol), the mean MPR was 80%, and 51% reported perfect adherence to their diabetes medications. In both unadjusted and adjusted analyses, there were no differences in glucose control and medication adherence by collocation of care. Patients seen in collocated care tended to have better HbA1c levels (ß = -0.149; P = 0.393) and MPR values (ß = 0.34; P = 0.132) and worse self-reported adherence (odds ratio 0.71; P = 0.143), but these were not statistically significant. CONCLUSIONS: In a population of veterans with comorbid diabetes and SMI, patients on average had good glucose control and medication adherence regardless of where they received primary care.


Sujet(s)
Glycémie/métabolisme , Diabète de type 2/épidémiologie , Accessibilité des services de santé/statistiques et données numériques , Adhésion au traitement médicamenteux/statistiques et données numériques , Troubles mentaux/épidémiologie , Anciens combattants/statistiques et données numériques , Adulte , Sujet âgé , Études de cohortes , Études transversales , Diabète de type 2/sang , Diabète de type 2/complications , Diabète de type 2/traitement médicamenteux , Femelle , Humains , Hypoglycémiants/usage thérapeutique , Mâle , Troubles mentaux/complications , Troubles mentaux/thérapie , Services de santé mentale/organisation et administration , Adulte d'âge moyen , Soins de santé primaires/organisation et administration , Indice de gravité de la maladie , États-Unis/épidémiologie , Department of Veterans Affairs (USA)/organisation et administration
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