CRANIUM: a quasi-experimental study to improve metabolic screening and HIV testing in community mental health clinics compared to usual care
Abstract Background Individuals with serious mental illness often do not receive guideline-concordant metabolic screening and human immunodeficiency virus (HIV) testing, contributing to increased morbidity and premature mortality. This study evaluates the effectiveness of CRANIUM (Cardiometabolic Ri...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-11-01
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| Series: | BMC Psychiatry |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12888-022-04293-4 |
| _version_ | 1828329900017188864 |
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| author | Alison R. Hwong D. Nyasha Chagwedera Marilyn Thomas Grace Niu Judy Quan Eric Vittinghoff Dean Schillinger John W. Newcomer Ana Gonzalez Susan Essock Christina Mangurian |
| author_facet | Alison R. Hwong D. Nyasha Chagwedera Marilyn Thomas Grace Niu Judy Quan Eric Vittinghoff Dean Schillinger John W. Newcomer Ana Gonzalez Susan Essock Christina Mangurian |
| author_sort | Alison R. Hwong |
| collection | DOAJ |
| description | Abstract Background Individuals with serious mental illness often do not receive guideline-concordant metabolic screening and human immunodeficiency virus (HIV) testing, contributing to increased morbidity and premature mortality. This study evaluates the effectiveness of CRANIUM (Cardiometabolic Risk Assessment and treatment through a Novel Integration model for Underserved populations with Mental illness), an intervention to increase metabolic screening and HIV testing among patients with serious mental illness in a community mental health clinic compared to usual care. Methods The study used a quasi-experimental design, prospectively comparing a preventive care screening intervention at one community mental health clinic (n = 536 patients) to usual care at the remaining clinics within an urban behavioural health system (n = 4,847 patients). Psychiatrists at the intervention site received training in preventive health screening and had access to a primary care consultant, screening and treatment algorithms, patient registries, and a peer support specialist. Outcomes were the change in screening rates of A1c, lipid, and HIV testing post-intervention at the intervention site compared to usual care sites. Results Rates of lipid screening and HIV testing increased significantly at the intervention site compared to usual care, with and without multivariable adjustment [Lipid: aOR 1.90, 95% CI 1.32–2.75, P = .001; HIV: aOR 23.42, 95% CI 5.94–92.41, P < .001]. While we observed a significant increase in A1c screening rates at the intervention site, this increase did not persist after multivariable adjustment (aOR 1.37, 95% CI .95–1.99, P = .09). Conclusions This low-cost, reverse integrated care model targeting community psychiatrist practices had modest effects on increasing preventive care screenings, with the biggest effect seen for HIV testing rates. Additional incentives and structural supports may be needed to further promote screening practices for individuals with serious mental illness. |
| first_indexed | 2024-04-13T20:32:01Z |
| format | Article |
| id | doaj.art-1ae74ae5e7124c25bc57b49889142a68 |
| institution | Directory Open Access Journal |
| issn | 1471-244X |
| language | English |
| last_indexed | 2024-04-13T20:32:01Z |
| publishDate | 2022-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Psychiatry |
| spelling | doaj.art-1ae74ae5e7124c25bc57b49889142a682022-12-22T02:31:08ZengBMCBMC Psychiatry1471-244X2022-11-012211810.1186/s12888-022-04293-4CRANIUM: a quasi-experimental study to improve metabolic screening and HIV testing in community mental health clinics compared to usual careAlison R. Hwong0D. Nyasha Chagwedera1Marilyn Thomas2Grace Niu3Judy Quan4Eric Vittinghoff5Dean Schillinger6John W. Newcomer7Ana Gonzalez8Susan Essock9Christina Mangurian10Department of Psychiatry and Behavioral Sciences, University of California, San FranciscoUCSF School of MedicineDepartment of Psychiatry and Behavioral Sciences, University of California, San FranciscoDepartment of Epidemiology and Biostatistics, UCSFDepartment of Epidemiology and Biostatistics, UCSFDepartment of Epidemiology and Biostatistics, UCSFUCSF Center for Vulnerable Populations at Zuckerberg San Francisco General HospitalThriving Mind South FloridaDepartment of Psychiatry and Behavioral Sciences, University of California, San FranciscoDepartment of Psychiatry, Washington University School of MedicineDepartment of Psychiatry and Behavioral Sciences, University of California, San FranciscoAbstract Background Individuals with serious mental illness often do not receive guideline-concordant metabolic screening and human immunodeficiency virus (HIV) testing, contributing to increased morbidity and premature mortality. This study evaluates the effectiveness of CRANIUM (Cardiometabolic Risk Assessment and treatment through a Novel Integration model for Underserved populations with Mental illness), an intervention to increase metabolic screening and HIV testing among patients with serious mental illness in a community mental health clinic compared to usual care. Methods The study used a quasi-experimental design, prospectively comparing a preventive care screening intervention at one community mental health clinic (n = 536 patients) to usual care at the remaining clinics within an urban behavioural health system (n = 4,847 patients). Psychiatrists at the intervention site received training in preventive health screening and had access to a primary care consultant, screening and treatment algorithms, patient registries, and a peer support specialist. Outcomes were the change in screening rates of A1c, lipid, and HIV testing post-intervention at the intervention site compared to usual care sites. Results Rates of lipid screening and HIV testing increased significantly at the intervention site compared to usual care, with and without multivariable adjustment [Lipid: aOR 1.90, 95% CI 1.32–2.75, P = .001; HIV: aOR 23.42, 95% CI 5.94–92.41, P < .001]. While we observed a significant increase in A1c screening rates at the intervention site, this increase did not persist after multivariable adjustment (aOR 1.37, 95% CI .95–1.99, P = .09). Conclusions This low-cost, reverse integrated care model targeting community psychiatrist practices had modest effects on increasing preventive care screenings, with the biggest effect seen for HIV testing rates. Additional incentives and structural supports may be needed to further promote screening practices for individuals with serious mental illness.https://doi.org/10.1186/s12888-022-04293-4Integrated careCollaborative careSerious mental illnessHealth care disparitiesDiabetes |
| spellingShingle | Alison R. Hwong D. Nyasha Chagwedera Marilyn Thomas Grace Niu Judy Quan Eric Vittinghoff Dean Schillinger John W. Newcomer Ana Gonzalez Susan Essock Christina Mangurian CRANIUM: a quasi-experimental study to improve metabolic screening and HIV testing in community mental health clinics compared to usual care BMC Psychiatry Integrated care Collaborative care Serious mental illness Health care disparities Diabetes |
| title | CRANIUM: a quasi-experimental study to improve metabolic screening and HIV testing in community mental health clinics compared to usual care |
| title_full | CRANIUM: a quasi-experimental study to improve metabolic screening and HIV testing in community mental health clinics compared to usual care |
| title_fullStr | CRANIUM: a quasi-experimental study to improve metabolic screening and HIV testing in community mental health clinics compared to usual care |
| title_full_unstemmed | CRANIUM: a quasi-experimental study to improve metabolic screening and HIV testing in community mental health clinics compared to usual care |
| title_short | CRANIUM: a quasi-experimental study to improve metabolic screening and HIV testing in community mental health clinics compared to usual care |
| title_sort | cranium a quasi experimental study to improve metabolic screening and hiv testing in community mental health clinics compared to usual care |
| topic | Integrated care Collaborative care Serious mental illness Health care disparities Diabetes |
| url | https://doi.org/10.1186/s12888-022-04293-4 |
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