Skip to main content

Advertisement

SpringerLink
Log in

Exploring Primary Care Activities in ACT Teams

  • Original Paper
  • Published:
Community Mental Health Journal Aims and scope Submit manuscript

Abstract

People with serious mental illness often receive inadequate primary and preventive care services. Federal healthcare reform endorses team-based care that provides high quality primary and preventive care to at risk populations. Assertive community treatment (ACT) teams offer a proven, standardized treatment approach effective in improving mental health outcomes for the seriously mentally ill. Much is known about the effectiveness of ACT teams in improving mental health outcomes, but the degree to which medical care needs are addressed is not established. The purpose of this study was to explore the extent to which ACT teams address the physical health of the population they serve. ACT team leaders were invited to complete an anonymous, web-based survey to explore attitudes and activities involving the primary care needs of their clients. Information was collected regarding the use of health screening tools, physical health assessments, provision of medical care and collaboration with primary care systems. Data was analyzed from 127 team leaders across the country, of which 55 completed the entire survey. Nearly every ACT team leader believed ACT teams have a role in identifying and managing the medical co-morbidities of their clientele. ACT teams report participation in many primary care activities. ACT teams are providing a substantial amount of primary and preventive services to their population. The survey suggests standardization of physical health identification, management or referral processes within ACT teams may result in improved quality of medical care. ACT teams are in a unique position to improve physical health care by virtue of having medically trained staff and frequent, close contact with their clients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Allness, D., Knoedler, W. (1998). The PACT model of community-based treatment for persons with severe and persistent mental illnesses: A manual for PACT start up. National Alliance for the Mentally Ill.

  • Barnes, T. R. E., Paton, C., Cavanagh, M.-R., Hancock, E., & Taylor, D. M. (2007). A UK audit of screening for the metabolic side effects of antipsychotics in community patients. Schizophrenia Bulletin, 33, 1397–1403.

    Article  PubMed Central  PubMed  Google Scholar 

  • Bond, G. R., Drake, R., Mueser, K., & Latimer, E. (2001). Assertive community treatment for people with severe mental illness—critical ingredients and impact on patients. Disease Management and Health Outcomes, 9, 141–159.

    Article  Google Scholar 

  • Ceilley, J. W., Cruz, M., & Denko, T. (2006). Active medical conditions among patients on an assertive community treatment team. Community Mental Health Journal, 42, 205–211.

    Article  PubMed  Google Scholar 

  • Coldwell, C. M., & Bender, W. S. (2007). The effectiveness of assertive community treatment for homeless populations with severe mental illness: A meta-analysis. American Journal of Psychiatry, 164(March), 393–399.

    Article  PubMed  Google Scholar 

  • Dixon, L. (2000). Assertive community treatment: Twenty-five years of gold. Psychiatric Services, 51, 759–765.

    Article  PubMed  CAS  Google Scholar 

  • Drake, R. E., & Deegan, P. E. (2008). Are assertive community treatment and recovery compatible? Commentary on “ACT and recovery: Integrating evidence-based practice and recovery orientation on assertive community treatment teams”. Community Mental Health Journal, 44(1), 75–77. doi:10.1007/s10597-007-9120-9.

    Article  PubMed  Google Scholar 

  • Druss, B. G., Rosenheck, R. A., Desai, M. M., & Perlin, J. B. (2002). Quality of preventive medical care for patients with mental disorders. Medical Care, 40(2), 129–136.

    Article  PubMed  Google Scholar 

  • Druss, B. G., von Esenwein, S., Compton, M. T., Rask, K. J., Zhao, L., & Parker, R. M. (2010). A randomized trial of medical care management for community mental health settings: The primary care access, referral, and evaluation (PCARE) study. The American journal of psychiatry, 167(2), 151–159.

    Article  PubMed Central  PubMed  Google Scholar 

  • Gold, P., Meisler, N., & Santos, A. (2003). Implementation and dissemination of an evidence-based model of community based care for persons with severe and persistent mental illness. Cognitive and Behavioral Practice, 10, 290–303.

    Article  Google Scholar 

  • Harris, P., Tayler, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. (2009). Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381.

    Article  PubMed Central  PubMed  Google Scholar 

  • Horvitz-Lennon, M., Kilbourne, A. M., & Pincus, H. A. (2006a). From silos to bridges: Meeting the general health care needs of adults with severe mental illnesses. Health Affairs (Project Hope), 25(3), 659–669.

    Article  Google Scholar 

  • Horvitz-Lennon, M., Kilbourne, A. M., & Pincus, H. A. (2006b). From silos to bridges: Meeting the general health care needs of adults with severe mental illnesses. Health Affairs (Project Hope), 25(3), 659–669.

    Article  Google Scholar 

  • Kane, C. F., & Blank, M. B. (2004). NPACT: Enhancing programs of assertive community treatment for the seriously mentally ill. Community Mental Health Journal, 40, 549–559.

    Article  PubMed  Google Scholar 

  • Latimer, E. (1999). Economic impacts of assertive community treatment: A review of the literature. Canadian Journal of Psychiatry, 44, 443–454.

    CAS  Google Scholar 

  • Laursen, T. M. (2011). Life expectancy among persons with schizophrenia or bipolar affective disorder. Schizophrenia Research, 131(1–3), 101–104.

    Article  PubMed  Google Scholar 

  • Lawrence D, Kisely S. (2010). Inequalities in healthcare provision for people with severe mental illness. Journal of Psychopharmacology 24(11) Supplement 4:61–68.

    Google Scholar 

  • Mitchell, A. J., Delaffon, V., Vancampfort, D., Correll, C. U., & De Hert, M. (2012). Guideline concordant monitoring of metabolic risk in people treated with antipsychotic medication: Systematic review and meta-analysis of screening practices. Psychological Medicine, 42, 125–147.

    Article  PubMed  CAS  Google Scholar 

  • Monroe-Devita, M., Morse, G., & Bond, G. R. (2012). Program fidelity and beyond: Multiple strategies and criteria for ensuring quality of assertive community treatment. Psychiatric Services (Washington, D.C.), 63(8), 3–10.

    Article  Google Scholar 

  • Monroe-DeVita, M., Teague, G. B., Moser, L. L., & TMACT. (2011). A new tool for measuring fidelity to assertive community treatment. Journal of the American Psychiatric Nurses Association, 17(1), 17–29.

    Article  PubMed  Google Scholar 

  • Morden, N., Mistler, L., Weeks, W., & Bartels, S. (2009). Health care for patients with serious mental illness: Family medicine’s role. Journal of the American Board of Family Medicine, 22, 187–195.

    Article  PubMed Central  PubMed  Google Scholar 

  • Morrato, E. H., Nicol, G. E., Maahs, D., Druss, B. G., Hartung, D. M., Valuck, R. J., et al. (2010). Metabolic screening in children receiving antipsychotic drug treatment. Archives of Pediatrics and Adolescent Medicine, 164, 344–351.

    Article  PubMed  Google Scholar 

  • NCQA’s Patient-Centered Medical Home (PCMH) (2011) Standards 11/21/11. (2011). Retrieved August 1, 2012, from http://www.ncqa.org/tabid/631/Default.aspx.

  • President’s New Freedom Commission on Mental Health, Achieving the Promise: Transforming Mental Health Care in America. (2003). Retrieved August 1, 2012 http://www.mentalhealthcommission.gov/reports/reports.htm.

  • Saha, S., Chant, D., & McGrath, J. (2007). A systematic review of mortality in schizophrenia: Is the differential mortality gap worsening over time? Archives of General Psychiatry, 64, 1123–1131.

    Article  PubMed  Google Scholar 

  • Shattell, M., Donnelly, N., Scheyett, A., & Cuddeback, G. S. (2011). Assertive community treatment and the physical health needs of persons with severe mental illness: Issues around integration of mental health and physical health. Journal of the American Psychiatric Nurses Association, 17(1), 57–63.

    Article  PubMed  Google Scholar 

  • Smith, T. E., & Sederer, L. I. (2009). A new kind of homelessness for individuals with serious mental illness? The need for a “mental health home”. Psychiatric Services (Washington, D.C.), 60(4), 528–533.

    Article  Google Scholar 

  • Sodhi, S. K., Linder, J., Chenard, C. A., Miller, D. D., Haynes, W. G., & Fiedorowicz, J. G. (2012). Evidence for accelerated vascular aging in bipolar disorder. Journal of Psychosomatic Research, 73(3), 175–179.

    Article  PubMed Central  PubMed  Google Scholar 

  • Teague, G. B., Bond, G. R., & Drake, R. E. (1998). Program fidelity in assertive community treatment: Development and use of a measure. American Journal of Orthopsychiatry, 68(2), 216–232.

    Article  PubMed  CAS  Google Scholar 

  • Wagner, E. (2001). Meeting the needs of chronically ill people. BMJ, 323, 945–946.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  • Weinstein, L., Henwood, B., Cody, J., Jordan, M., & Lelar, R. (2011). Transforming assertive community treatment into an integrated care system: The role of nursing and primary care partnerships. Journal of the American Psychiatric Nurses Association, 17(1), 64–71.

    Article  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Family Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA

    Erik R. Vanderlip

  2. Department of Psychiatry, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA

    Erik R. Vanderlip, Nancy A. Williams & Jess G. Fiedorowicz

  3. Department of Internal Medicine Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA

    Jess G. Fiedorowicz

  4. Department of Epidemiology, College of Public Health, The University of Iowa, 105 River Street, Iowa City, IA, 52242, USA

    Jess G. Fiedorowicz

  5. Department of Psychiatry, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA

    Erik R. Vanderlip & Wayne Katon

Authors
  1. Erik R. Vanderlip
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nancy A. Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jess G. Fiedorowicz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wayne Katon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Erik R. Vanderlip.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vanderlip, E.R., Williams, N.A., Fiedorowicz, J.G. et al. Exploring Primary Care Activities in ACT Teams. Community Ment Health J 50, 466–473 (2014). https://doi.org/10.1007/s10597-013-9673-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10597-013-9673-8

Keywords

Search

Navigation