Improving quality of care for mental illness in an uninsured, low-income primary care population

ObjectiveWe assessed if an ongoing, multifaceted quality improvement program improved mental health care in a low-income, uninsured primary care clinic.MethodsWe reviewed the charts of 500 consecutive patients in 1999 and 500 consecutive patients in 2004 to compare the number of mental health visits; the percentage of patients with more than three follow-up visits; the percentage with ≥1 visit with a prescribing provider and the percentage with a psychiatric medication prescribed. We also assessed whether patients with more than one charted mental illness received more care than patients with one mental illness.ResultsCompared to 1999, patients in 2004 had significantly more visits in the first 120 days (acute phase) of treatment (3.16 vs. 4.81, P<.001) and more visits in up to 9 months post acute phase (3.76 vs. 4.88, P>.012). A higher percentage of patients in the acute phase (28.9% vs. 49.5%, P<.001) had three follow-up visits, saw a medical provider and received a prescription. Patients with multiple charted mental illnesses had more visits than patients with one mental illness in 2004 but not in 1999 (P<.001).ConclusionsAn ongoing, multifaceted intervention improved the quality of mental health care in a primary care population with a high prevalence of mental illness.