Personal health records help mentally ill patients with comorbidities access medical services



Personal health records can help people with serious mental illnesses and comorbid medical conditions improve the quality of their medical care, according to a randomized trial of 170 patients.

Patients with serious mental illnesses and at least one comorbid medical condition were recruited from a community mental health center by Dr. Benjamin G. Druss, professor and Rosalynn Carter Chair in Mental Health at Emory University in Atlanta, and his colleagues. The mean age of the patients was 49; most (83.5%) were African American and had a mean annual income of less than $7,000. Nearly half had major depression and 28% had schizophrenia. Other patients had schizoaffective disorder, bipolar disorder, or posttraumatic stress disorder. Overall, patients had an average 2.3 comorbid chronic medical diagnoses such as diabetes, hyperlipidemia, and hypertension.

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A small trial showed that personal health records improved the quality of care and increased use of medical services for people with serious mental illnesses and comorbidities.

The investigators assigned half of the patients to use of a personal health record (PHR) for a 1-year period and helped patients set them up; the other half did not use PHRs (Am. J. Psychiatry 2014;171:360-8).

Dr. Druss and his colleagues adapted an available PHR system for participants by rewriting elements to a sixth-grade reading level, adding a section on mental health and health goals, adding a mental health advanced directive section listing patient preferences for mental health care, and providing a list of resources such as local grocery stores and health providers in patients’ neighborhoods. They gave participants computer training and set up a computer workstation at the mental health clinic.

Overall, those in the PHR group accessed their PHRs an average of 42 times over the course of the year. The proportion of eligible preventive services received "increased in the PHR group from 24% at baseline to 40% at the 12-month follow-up, compared with a decline in the usual care group from 25% to 18% (P less than .001)." The PHR group had "significantly greater improvements in rates of physical examination (P less than .001), screening (P = .02), vaccination (P less than .001), and education (P less than .001)."

Among 118 patients with cardiometabolic conditions, the proportion of cardiometabolic services received "improved by 2 percentage points in the personal health record group but declined by 11 percentage points in the usual care group, resulting in a significant difference in change between the two groups (P = .003)."

"Having a personal health record resulted in significantly improved quality of medical care and increased use of medical services among patients," Dr. Druss and his colleagues wrote. "Personal health records could provide a relatively low-cost, scalable strategy for improving medical care for patients with comorbid medical and serious mental illnesses."

The limitations cited by Dr. Druss and his colleagues included the study’s focus on patients in one urban community health center. "Further work is needed to establish generalizability to other mental health settings," they wrote. Also, the study focused on those patients who had a regular mental health care provider, which suggests that access issues would need to be addressed for those without a regular source of care before this kind of approach could be broadly implemented.

The study was supported by the Agency for Healthcare Research and Quality. The authors reported no relevant financial conflicts of interest.

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