OBJECTIVE: Mentally ill persons represent a population that is potentially vulnerable to receiving a poorer quality of medical care. This study examines the relationship between mental disorders and the likelihood of receiving recommended nutrition and exercise counseling. DESIGN: Cross-sectional study combining chart-review data and administrative database records. SETTING: One hundred forty-seven Veterans Affairs (VA) medical centers nationwide. PATIENTS/PARTICIPANTS: The sample included 90,240 patients with obesity and/or hypertension who had >/=3 medical outpatient visits in the previous year. MEASUREMENTS AND MAIN RESULTS: The outcomes of interest were chart-documented receipt of nutrition counseling and receipt of exercise counseling in the past 2 years. This chart information was merged with VA inpatient and outpatient administrative databases, which were used to identify persons with diagnosed mental disorders. Most patients received nutrition counseling (90.4%), exercise counseling (88.5%), and counseling for both (85.7%) in the past 2 years. The rates of counseling differed significantly but modestly by mental health status. The lowest rates were found among patients dually diagnosed with comorbid psychiatric and substance use disorders; however, the magnitude of the disparities was small, ranging from 2% to 4% across outcomes. These results were unchanged after controlling for demographics, health status, and facility characteristics using multivariable generalized estimating equation modeling. CONCLUSIONS: Among patients engaged in active medical treatment, rates of nutrition and exercise counseling were high at VA medical centers, and the diagnosis of mental illness was not a substantial barrier to such counseling. More work is needed to determine whether these findings generalize to non-VA settings and to understand the potential role that integrated systems such as the VA can play in reducing disparities for vulnerable populations.
OBJECTIVE: Mentally ill persons represent a population that is potentially vulnerable to receiving a poorer quality of medical care. This study examines the relationship between mental disorders and the likelihood of receiving recommended nutrition and exercise counseling. DESIGN: Cross-sectional study combining chart-review data and administrative database records. SETTING: One hundred forty-seven Veterans Affairs (VA) medical centers nationwide. PATIENTS/PARTICIPANTS: The sample included 90,240 patients with obesity and/or hypertension who had >/=3 medical outpatient visits in the previous year. MEASUREMENTS AND MAIN RESULTS: The outcomes of interest were chart-documented receipt of nutrition counseling and receipt of exercise counseling in the past 2 years. This chart information was merged with VA inpatient and outpatient administrative databases, which were used to identify persons with diagnosed mental disorders. Most patients received nutrition counseling (90.4%), exercise counseling (88.5%), and counseling for both (85.7%) in the past 2 years. The rates of counseling differed significantly but modestly by mental health status. The lowest rates were found among patients dually diagnosed with comorbid psychiatric and substance use disorders; however, the magnitude of the disparities was small, ranging from 2% to 4% across outcomes. These results were unchanged after controlling for demographics, health status, and facility characteristics using multivariable generalized estimating equation modeling. CONCLUSIONS: Among patients engaged in active medical treatment, rates of nutrition and exercise counseling were high at VA medical centers, and the diagnosis of mental illness was not a substantial barrier to such counseling. More work is needed to determine whether these findings generalize to non-VA settings and to understand the potential role that integrated systems such as the VA can play in reducing disparities for vulnerable populations.
Authors: D C Henderson; E Cagliero; C Gray; R A Nasrallah; D L Hayden; D A Schoenfeld; D C Goff Journal: Am J Psychiatry Date: 2000-06 Impact factor: 18.112
Authors: D B Allison; J L Mentore; M Heo; L P Chandler; J C Cappelleri; M C Infante; P J Weiden Journal: Am J Psychiatry Date: 1999-11 Impact factor: 18.112
Authors: Arpita Aggarwal; Karen Freund; Alicia Sato; Lucille L Adams-Campbell; Ana Maria Lopez; Lawrence S Lessin; Judith Ockene; Robert B Wallace; Carla D Williams; Denise E Bonds Journal: J Womens Health (Larchmt) Date: 2008-10 Impact factor: 2.681
Authors: Jeffrey F Scherrer; Joanne Salas; Kathleen M Chard; Peter Tuerk; Carissa van den Berk-Clark; F David Schneider; Beth E Cohen; Patrick J Lustman; Paula P Schnurr; Matthew J Friedman; Sonya B Norman Journal: J Psychosom Res Date: 2019-10-15 Impact factor: 3.006
Authors: Richard A Labrie; Debi A Laplante; Allyson J Peller; Donald E Christensen; Kristina L Greenwood; John H Straus; Michael S Garmon; Cheryl Browne; Howard J Shaffer Journal: Int J Integr Care Date: 2007-05-16 Impact factor: 5.120