Utilization and Adherence in Medical Homes
An Assessment of Rural-Urban Differences for People With Severe Mental Illness
Bibliographic Data
| ID | 9100363 |
|---|---|
| Authors | Mona Kilany (0000-0002-4313-1997, University of North Carolina at Chapel Hill, corresponding author), Joseph P Morrissey (University of North Carolina at Chapel Hill), J Morrissey (0000-0001-6289-9224, University of North Carolina at Chapel Hill, corresponding author), Marisa Elena Domino (0000-0003-4845-6261, University of North Carolina at Chapel Hill, corresponding author), Kathleen C Thomas (0000-0002-1611-5393, University of North Carolina at Chapel Hill, corresponding author), Pam Silberman (University of North Carolina at Chapel Hill, corresponding author) |
| Year | 2018 |
| Volume | 56 |
| Issue | 10 |
| Pages | 870-876 |
| Publication date | 2018-10-01 |
| Open Access | No |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/mlr.0000000000000973 |
| PMID | 30211809 |
| OpenAlex | W2889703242 |
| Language | EN |
| Citations received | 2 |
| References cited | 30 |
BACKGROUND: The complex nature of managing care for people with severe mental illness (SMI), including major depression, bipolar disorder, and schizophrenia, is a challenge for primary care practices, especially in rural areas. The team-based emphasis of medical homes may act as an important facilitator to help reduce observed rural-urban differences in care. OBJECTIVE: The objective of this study was to examine whether enrollment in medical homes improved care in rural versus urban settings for people with SMI. RESEARCH DESIGN: Secondary data analysis of North Carolina Medicaid claims from 2004-2007, using propensity score weights and generalized estimating equations to assess differences between urban, nonmetropolitan urban and rural areas. SUBJECTS: Medicaid-enrolled adults with diagnoses of major depressive disorder, bipolar disorder or schizophrenia. Medicare/Medicaid dual eligibles were excluded. MEASURES: We examined utilization measures of primary care use, specialty mental health use, inpatient hospitalizations, and emergency department use and medication adherence. RESULTS: Rural medical home enrollees generally had higher primary care use and medication adherence than rural nonmedical home enrollees. Rural medical home enrollees had fewer primary care visits than urban medical home enrollees, but both groups were similar on the other outcome measures. These findings varied somewhat by SMI diagnosis. CONCLUSIONS: Findings indicate that enrollment in medical homes among rural Medicaid beneficiaries holds the promise of reducing rural-urban differences in care. Both urban and rural medical homes may benefit from targeted resources to help close the remaining gaps and to improve the success of the medical home model in addressing the health care needs of people with SMI
Family medicine · Health care · Medicaid · Medical home · Mental health · Mental illness · Primary care · Psychiatry · Rural area · Specialty · Family Caregiving in Mental Illness · Medicine · Primary Care and Health Outcomes · Schizophrenia research and treatment · Gerontology
Twelve-Month Use of Mental Health Services in the United States
Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group
Use of Critical Access Hospital Emergency Rooms by Patients With Mental Health Symptoms
Access to Rural Mental Health Services
Patient-Centered Medical Homes
Defining Urban and Rural Areas in U.S. Epidemiologic Studies
How 3 Rural Safety Net Clinics Integrate Care for Patients
Use of Medical Homes by Patients With Comorbid Physical and Severe Mental Illness
| Citations per year | 0.33 |
|---|---|
| Citation span | 2020 - 2021 (2) |
| Highly cited | No |