A randomized clinical trial investigating the effect of a healthcare access model for individuals with severe psychiatric disabilities

Background: Physical co-morbidities lead to shortened lifespans among individuals with severe mental illness.  Factors affecting this greater morbidity and mortality include lack of access to health care and a lack of integrated physical and mental healthcare.

Method:  We conducted a randomized clinical trial to examine the effects of an innovative model for integrating primary healthcare into a behavioral healthcare setting. We examined whether this model effectively addressed issues of healthcare access and integration and whether it resulted in improved health and functioning. A total of 200 individuals were recruited, screened, assessed, and randomly assigned to either the experimental arm of the study to receive primary care delivered by a nurse practitioner (NP) who was employed by the behavioral healthcare agency (n=94), or to a control arm providing mental health services-as-usual (n=106). Individuals were assessed on a variety of measures including perceived health status, functioning and psychiatric symptoms.

Findings:  ITT analyses using mixed linear regression models suggested no difference between the experimental and control study participants over time or between groups on any health, functioning, or symptom outcome. However, because a sizable proportion of study participants were not exposed to the experimental intervention, we conducted secondary analyses, factoring in exposure to the intervention. We found that individuals receiving the intervention had poorer health status at baseline and that they experienced some improvements when compared to subjects receiving services-as-usual. Health benefits accrued for individuals whose primary care needs were addressed by a nurse practitioner within a mental health setting.