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Integrating Primary Care Into Assertive Community Treatment.

Jeanie Tse1, Jason E Cheng1, Edward Tabasky1

  • 1Institute for Community Living, New York City (Tse, Tabasky, Kingman, LaStella, Woodlock); Department of Psychiatry, New York University School of Medicine, New York City (Tse); Department of Psychiatry and Behavioral Sciences, Meharry Medical College, Nashville, Tennessee (Cheng); Department of Veterans Affairs New York Harbor, New York City (Quitangon).

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Integrating primary care nurse practitioners into assertive community treatment (ACT) improved patient engagement and increased health screenings. This model offers a sustainable approach to primary care for ACT participants.

Keywords:
Assertive community treatmentCommunity psychiatryPrimary careintegrated care

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Area of Science:

  • Healthcare delivery
  • Primary care integration
  • Mental health services

Background:

  • Assertive Community Treatment (ACT) teams provide intensive community-based services for individuals with severe mental illness.
  • Integrating primary care into mental health settings can address unmet health needs and improve outcomes.
  • Primary care nurse practitioners (PCNPs) are well-positioned to provide essential health services.

Purpose of the Study:

  • To evaluate the integration of PCNPs into ACT teams.
  • To assess the impact of integrated primary care on patient engagement and health screening rates.
  • To explore the experiences of staff and participants with integrated primary care.

Main Methods:

  • A program evaluation was conducted from January to June 2019.
  • PCNPs in a postgraduate fellowship were assigned to five ACT teams (N=305 participants).
  • Focus groups were used to gather qualitative data from staff and participants. Screening rates for hemoglobin A1c and cholesterol were compared over time.

Main Results:

  • Staff and participants reported improved engagement in primary care due to colocation and consultation.
  • Field visits by PCNPs were not found to be an efficient use of their time for most ACT participants.
  • A significant increase in health screening rates was observed after six months for ACT teams with integrated primary care.

Conclusions:

  • Integrating PCNPs into ACT teams enhances participant engagement and facilitates primary care access.
  • A PCNP readily available for participant engagement and consultation, supported by a cardiometabolic registry, presents a sustainable integration model.
  • This model can improve the delivery of essential health services to individuals receiving ACT.