Center for Health Equity Research and Promotion

Does Collocation of Primary Care and Mental Health Care Matter?

VA-funded Study Addresses Quality of Collocated Care for Veterans

Veterans with both diabetes and serious mental illness are highly vulnerable and rely heavily on VHA care.  A recent VA-funded study led by CHERP researchers compared quality and outcomes for a sample of patients at three VISN4 facilities.  At two of the sites, behavioral health and primary care are collocated.  At the third site, patients go to one place for usual care and another for mental health care. 

This project addressed important priorities for Veterans health care, evaluated how care is provided in our model of patient centered care (PACT), and incorporated work in three different VA medical facilities with varied patient populations and resources. 

The journal Diabetes Care featured an article about the study in their August 2014 issue, titled Glucose Control and Medication Adherence Among Veterans With Diabetes and Serious Mental Illness:  Does Collocation of Primary Care and Mental Health Care Matter?  The primary author is Judith A. Long, MD, Core Investigator with the VA Center for Health Equity Research and Promotion (CHERP).  Her co-authors include Adam Gordon, MD, of CHERP’s Pittsburgh site, and Steven C. Marcus, PhD, of CHERP in Philadelphia.  The title of the study is Determinants of Diabetes Control in Veterans with Serious Mental Illness.  (IIR 07-124)

Dr. Long’s novel research design involved three different VA medical facilities in VISN4 – two sites that provide both collocated and usual care and one site that provided only usual care.  With this approach, the team could evaluate and compare glucose control and diabetes medication adherence among patients with serious mental illness in both settings.  Their results also serve to inform models of care, especially Patient Aligned Care Teams (PACT) for other high risk comorbid medical conditions that are also common among Veterans who use VHA services. 

In this cross-sectional, observational cohort study of 363 Veteran patients, Dr. Long and colleagues found that these Veterans with comorbid diabetes and SMI on average had good glucose control and medication adherence regardless of whether the VHA facility where they received care had collocated mental health care or not.  This has important implications providing quality health care for a vulnerable population of Veterans.
Read full article:  http://care.diabetesjournals.org/content/37/8.toc