Integrated Care for Veterans with Diabetes DM

1
Integrated Care for Veterans with Diabetes (DM)
Serious Mental Illness (SMI)
J.A. Long1,2 S.C. Marcus2 1VA Center for Health
Equity Research and Promotion, Philadelphia, PA
2University of Pennsylvania, Philadelphia, PA.
Background
Methods
Results
Conclusions

• DM 2-3 times more common in patient with SMI
• Death rates due to DM and CAD among SMI patients
  are 2-3 higher than non-SMI patients
• DM Medication adherence and glucose control is
  poor among SMI patients
• Integrated care where patients receive primary
  and mental health care within the same site
  advocated
• Integrated care shown to improve general health
• No studies looking at how integrated care affects
  disease specific outcomes

• Population Identified from VIREC VISN 4 Data
• Outcomes
• Medication Possession Ratio (MPR) for
  hypoglycemic meds during 12 months preceding the
  last recorded HbA1c
• good adherence (MPR 80)
• marginal adherence (MPR 50)
• HbA1c
• Main Predictor SMI in Integrated Care
• SMI Schizophrenia (any 295 ICD-9CM code) or
  bipolar disorder (code 296.4-296.7)
• At least one primary care appointment in behavior
  health clinic (code 531)
• Analysis
• Logistic or Linear regression

• Patients with SMI in integrated care had better
• DM medication adherence and
• Glucose control

Hypoglycemic Rx HS500,HS501, HS502
DM 250 ICD-9CM
HbA1c 2003-2006
Limitations/Planned Future Work

• Single institution/Multi-site study
• No adjustment for SMI severity/Primary data
  collection to determine severity
• Enrollment in integrated care non-random/Multi-sit
  e study including a site without integrated care
• Definition of being in integrated care
  generous/Confirm primary care site with PCP

Objectives

• Determine if integrated care is associated with
• improved
• - DM medication adherence, and
• - Glucose control
• In a population of veterans with both DM and
• SMI served by one VA medical center

Policy Implications

• Integrated care may be an important means of
  improving chronic disease management and disease
  specific outcomes for patients with SMI

Integrated Care in the PVAMC

• Located in the mental health clinic
• 1 MD, 3 NP, 1MA
• Part of the mental health team, attend mental
  clinic conferences and meetings
• 1/3 of appointment slots unscheduled to
  accommodate walk-ins and walk-overs