Cardiometabolic Assessment, Diagnosis, and Treatment of Chronic Medical Illnesses During an Inpatient Psychiatric Hospitalization: Colocated Medical Care Versus Treatment as Usual

Abstract

Background: Reverse colocation care models reduce lifestyle risk factors, emergency department visits, and readmissions. Persons with serious mental illness have higher than average rates of cardiovascular disease-related morbidity and mortality, with second-generation antipsychotics (SGAs) conferring added related risks. Little is written about reverse colocated medical care (RCL) in inpatient psychiatric settings. The objective of this study was to identify associations between screening, diagnosis, and treatment of chronic medical comorbidities and mode of medical care for patients discharged from 2 inpatient psychiatric units on SGAs.

Methods: This was a cross-sectional retrospective study of medical comorbidities identified and treated for adults consecutively admitted from January 1, 2015, to October 31, 2015, to 2 inpatient psychiatry units of an academic center and discharged on SGAs. One unit has a primary care team consisting of a physician assistant backed up by a medical doctor who provide medical care (RCL). The other unit has medical care provided by psychiatrists with hospitalists as needed (treatment as usual, TAU). We conducted a chart review of demographics, vital signs, laboratory values, diagnoses, and medications with comparative analysis of the evaluation, diagnosis, and treatment for hypertension, diabetes mellitus, hyperlipidemia, obesity, and tobacco use disorder.

Results: In total, 232 patients were discharged from the TAU group and 220 from the RCL group. Significantly more screening laboratory values (glucose, hemoglobin A1c, lipids) were obtained in the TAU group, while documented responses to abnormal tests were higher in the RCL group. Patients were more likely in the RCL group to be diagnosed with obesity, tobacco use disorder, and hyperlipidemia and to be treated for hypertension and hyperlipidemia.

Conclusions: Reverse colocated medical care is effective in improving screening, diagnosis, and treatment of chronic medical diseases among psychiatric inpatients.​.