Disease Burden Among Individuals with Severe Mental Illness in a Community Setting.

This study examines the prevalence of comorbid physical health conditions within a community sample of individuals with severe mental illness (SMI), compares them to a matched national sample without SMI, and identifies which comorbidities create the greatest disease burden for those with SMI. Self-reported health status, co-morbid medical conditions and perceived disease burden were collected from 203 adults with SMI. Prevalence of chronic health conditions was compared to a propensity-matched sample without SMI from the National Comorbidity Survey-Replication (NCS-R). Compared to NCS-R sample without SMI, our sample with SMI had a higher prevalence of seven out of nine categories of chronic health conditions. Chronic pain and headaches, as well as the number of chronic conditions, were associated with increased disease burden for individuals with SMI. Further investigation of possible interventions, including effective pain management, is needed to improve the health status of this population.

Clinical Outcomes in a Primary Care Practice Within a Center for Health Equity.

OBJECTIVE: A Center for Health Equity that included a primary care practice was built in a neighborhood affected by long-term disparities related to race and class in order to promote health equity within the population. Changes in blood pressure and HbA1c (glycated hemoglobin) over 2 years were examined to assess the impact of providing culturally appropriate and patient-centered care. METHODS: Data from June 1, 2012, to June 30, 2014 were obtained. Patients with high blood pressure or elevated HbA1c levels were treated according to evidence based guidelines. Blood pressure and HbA1c values at the first and last visit were compared using paired t tests. RESULTS: Of the 390 patients seen with a systolic pressure ≥140 mm Hg, 358 came back for at least 1 visit (92%). By the time of the last visit, 70% had values <140 mm Hg. Mean decreases for systolic and diastolic pressure between the first and last visit were statistically significant (both P < .001). Of the 88 patients seen with HbA1c values ≥7%, 68 came back for at least 1 visit (77%). By the last visit, 31% had values <7%. The change in mean HbA1c levels between the first and last visits was statistically significant (P = .001). CONCLUSION: Data from this report demonstrate statistically significant improved clinical outcomes among members of this community who sought and received care from physicians within this Center for Health Equity.

An examination of premature mortality among decedents with serious mental illness and those in the general population.

OBJECTIVES: The primary aim of this retrospective study of death records was to determine whether there were significant differences in years of potential life lost (YPLL) between decedents with serious and persistent mental illness at a community mental health center (N=647) and decedents in the general population (N=15,517) after the analysis adjusted for sociodemographic factors and cause of death. METHODS: Clinical case management files from a community mental health center were matched to state death records from 1998 to 2004 to identify decedents being treated for a serious and persistent mental illness. Differences in leading causes of death and YPLL were calculated with descriptive and multivariate methods. RESULTS: Mean+/-SD YPLL for the decedents with serious and persistent mental illness was 14.5+/-10.6, compared with 10.3+/-6.7 for the general population. Heart disease was the leading cause of death for both groups. Mean differences in YPLL after adjustment for gender, race, marital status, and education ranged from 1.7 years for chronic lower respiratory disease to 13.1 years for accidents and were significant for every leading cause of death. Differences in cause of death did not explain the difference in YPLL. Suicide, cancer, accidents, liver disease, and septicemia were differentially associated with YPLL for persons with serious and persistent mental illness. CONCLUSIONS: Suicide, cancer, accidents, liver disease, and septicemia increased premature mortality among persons with serious and persistent mental illness. Along with ongoing suicide prevention programs, efforts to integrate primary and psychiatric care should focus on these preventable causes of early death.

Academic health centers and public health departments: partnership matters.

BACKGROUND: The Institute of Medicine has called for increased population-based training for healthcare professions students, and particularly medical students. For this to be effective, students should receive such training in the locations where population-based approaches to care take place, such as public health departments (HDs). However, little is known about currently existing relationships between academic health centers (AHCs) and HDs. METHODS: During the spring and summer of 2003, e-mail surveys on this topic were sent to the 104 members of the Association of Academic Health Centers, and 500 members of the National Association of City and County Health Officers and the Association of State and Territorial Health Officers. Results were received from 50 AHCs and 201 HDs. RESULTS: Survey results suggest that large numbers of healthcare professions students--residents, medical students, and others--are currently being trained in many HDs nationwide. The web of relationships between AHCs and HDs extends beyond education into research, service, and other purposes. CONCLUSIONS: These preliminary results require verification. Nevertheless, they raise questions about the types and quality of the education being offered in health departments, the impact of AHC/HD relationships on both parties, and how existing relationships may be enhanced to meet current and future national needs.