Health care utilization and receipt of cholesterol testing by veterans with and those without mental illness

Screening for cardiovascular risk factors in adults with serious mental illness: a review of the evidence

“…Variation in rates of screening for cardiovascular risk factors in the population with SMI is likely caused by multiple factors, including providers’ experience treating persons with SMI, [ 49 ] co-located versus geographically separate medical and mental health services, [ 18 ] and degree of continuity and coordination among medical care providers [ 50 , 51 ]. Consistent with studies evaluating quality of care conducted in the overall US population, [ 52 , 53 ] screening rates for cardiovascular risk factors among those with SMI tended to be high in the Veterans Health Administration (VHA) [ 22 , 30 , 31 , 54 - 56 ]. This is likely due at least partly to the VHA’s ability, as a national system, to use electronic patient data to trigger standard screening protocols for cardiovascular risk factors [ 57 ].…”

“…One hundred percent of the population was taking antipsychotics for 13 of the measures, 22% of the population were taking antipsychotics for one of the measures, and antipsychotic use was not reported for three of the measures. Estimated rates of lipid testing among antipsychotic users with SMI ranged from 8% of beneficiaries in four commercial health plans during 2001-2006 [ 27 ] to 85% of veterans during 2000–2001 [ 30 ]. In the majority of studies, lipid screening rates among antipsychotic users were less than 50% (Table 2 ) [ 25 - 28 , 31 - 35 ].…”

Quality of medical care for people with and without comorbid mental illness and substance misuse: systematic review of comparative studies

“…We excluded studies examining receipt of screening or preventive services in individuals with and without mental health problems because this population had no proven medical illness at the time of study. [29][30][31][32][33][34] We also excluded those studies that looked at physical health or mortality but not quality of care. 35 We excluded studies that examined physical health markers but without assessment of quality of care/service delivery (such as those looking purely at glycosylated haemoglobin (HbA 1c ) control in diabetes).…”

“…Kaplowitz and colleagues stratified individuals by attendance, finding that those with psychiatric diagnoses received lower levels of care, but only in those who infrequently used out-patient services and this was reversed in those with more out-patient visits. 31 Therefore, although people with mental illness may have more frequent medical contact, it may be ineffective and the quality of care offered to individuals may be unsatisfactory in different medical settings. Thus frequency of attendance (uptake of care) appears to be largely independent of inferior quality of received care and therefore this factor cannot be supported as the main explanatory variable.…”

Let's get physical: improving the medical care of people with severe mental illness

“…Furthermore, even when attendance is high, quality of care can be low (Desai 2002;Goodwin 2004;Jones 2005;Salsberry 2005). Of course, low attendance and poor quality of care is a particularly bad combination (Kaplowitz 2006). Therefore, predictors of adequate care include measures of both quality and quantity, and deficits in either may result in failing care and poor medical outcomes .…”