Activating Older Adults With Serious Mental Illness for Collaborative Primary Care Visits

• Published in: Psychiatric rehabilitation journal 2013-12, Vol.36 (4), p.278-288
• Main Authors: Bartels, Stephen J., Aschbrenner, Kelly A., Rolin, Stephanie A., Hendrick, Delia Cimpean, Naslund, John A., Faber, Marjan J.
• Format: Article
• Language: English
• Subjects: Ability; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - psychology; Cardiovascular Risk; Cardiovascular System; Community Mental Health Centers; Cooperative Behavior; Female; Health; Health behavior; Health Services Accessibility; Health Status Disparities; Healthcare Disparities; Human; Humans; Integrated Services; Intervention; Male; Mental Disorders; Mental Disorders - epidemiology; Mental Disorders - psychology; Mental Disorders - therapy; Middle Aged; Office Visits; Older people; Outcome Assessment (Health Care) - statistics & numerical data; Outpatient Treatment; Patient education; Patient Education as Topic - methods; Patient Participation - psychology; Patient Satisfaction; Peer Group; Personal Autonomy; Physician patient relationships; Physician-Patient Relations; Pilot Projects; Primary care; Primary Health Care; Program Development; Risk Factors; Role Playing; Self Efficacy; Self-Help Groups; Serious Mental Illness; Social Behavior; Training
• ISSN: 1095-158X; 1559-3126
• DOI: 10.1037/prj0000024

Objective: Persons with serious mental illness frequently receive inadequate medical care and are more likely to experience difficulty navigating the health care system compared with the general population. To address this gap in quality, we developed a program of peer co-led collaborative activation training for primary care (CAT-PC) designed to improve "patient activation" and person-centered care in primary care visits for middle-aged and older adults with serious mental illness and cardiovascular risk. This report presents pilot study feasibility and participant outcomes for CAT-PC. Method: A pre-post pilot evaluation of CAT-PC included N = 17 adults (age ≥ 50) with serious mental illness and cardiovascular health risk conditions, and N = 6 primary care providers. CAT-PC consists of 9 weekly peer co-led patient education and skills training sessions and a 45-min video-based training for primary care providers. Pre-post measures included the Patient Activation Measure (PAM), Perceived Efficacy in Patient-Physician Interactions (PEPPI), Autonomy Preference Index (API) for preferred role in primary care encounters, and Social Skills Performance Assessment (SSPA) role-play test for medical visits. Results: All 17 participants attended 5 or more sessions. Post-intervention improvement was found for patient activation and simulated performance of medical visit communication skills. Trends were observed for improved self-efficacy in provider interactions and greater preference for a more collaborative role in decision-making. Conclusions and Implications: CAT-PC is a brief, peer co-led education and skills training intervention potentially improving patient activation in primary care encounters and providing an important missing component in emerging models of "patient-centered behavioral health homes" for this high-risk group.