Integrated healthcare has a positive impact on the physical and mental health of Severe Mental Health (SMD) clients in Ohio

Background: Individuals with severe mental disorders (SMD) struggle to get effective primary healthcare.  Consequently, SMD clients have poorer health outcomes and die an average of 15 years sooner than the general population. In response to the lack of medical care provided to their SMD clients, clinicians at Butler Behavioral Health Services (BBHS) partnered with their local federally qualified health center (FQHC), Primary Health Solutions (PHS), to integrate primary and behavioral healthcare using a patient centered medical home (PCMH) model.  Methods: Adult SMD patients with Medicaid qualifying for the Health Home were offered coordinated primary, behavioral health, and health promotional services targeting treatment of the whole person. Outcome measures including hemoglobin A1c (HbA1c) levels, low-density lipoprotein cholesterol (LDL-C) levels, systolic and diastolic blood pressure, patient health questionnaire (PHQ-9) scores, and body mass index (BMI) were obtained from October 2012 through September 2013.  For clients with at least two scores for each measure, baseline and follow-up comparisons were calculated.  Results: During this timeframe, 188 adult SMD clients received integrated health services from BBHS and PHS.  At intake, 32.2% of patients presented with an elevated HbA1c (>7%), 63.8% with high cholesterol (LDL-C > 100mg/dl), 42.4% with high blood pressure (>140/90), and 74.0% were considered to be overweight or obese (BMI >25). For all primary and behavioral health outcome measures obtained, improvement from baseline to follow-up occurred. Notably, for patients with a hyperlipidemia diagnosis and two LDL-C measures (n = 14), 9 patients (64.3%) demonstrated positive change in their LDL-C levels from baseline (Mean  = 124mg/dl) to follow-up (Mean = 91.4mg/dl). In addition, 50 (64.9%) patients with a hypertension diagnosis (n = 77) demonstrated a decrease in blood pressure from baseline (Mean = 145.6/89.5) to follow-up (Mean = 128.7/81.7), and 51 of the 111 overweight patients (45.9%) lost weight. Conclusions: Integrated patients from BBHS and PHS presented with poorer physical health compared to the general population (CDC). Providing these patients with coordinated and integrated primary and behavioral health care greatly improved their health outcomes, illustrating that the integrated strategies utilized by BBHS and PHS are positively affecting the health of their patients.