***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT The prevalence of medical disorders is high among substance abuse patients , yet medical services are seldom provided in coordination with substance abuse treatment . OBJECTIVE To examine differences in treatment outcomes and costs between integrated and independent models of medical and substance abuse care as well as the effect of integrated care in a subgroup of patients with substance abuse-related medical conditions ( SAMCs ) . DESIGN R and omized controlled trial conducted between April 1997 and December 1998 . SETTING AND PATIENTS Adult men and women ( n = 592 ) who were admitted to a large health maintenance organization chemical dependency program in Sacramento , Calif. INTERVENTIONS Patients were r and omly assigned to receive treatment through an integrated model , in which primary health care was included within the addiction treatment program ( n = 285 ) , or an independent treatment-as-usual model , in which primary care and substance abuse treatment were provided separately ( n = 307 ) . Both programs were group based and lasted 8 weeks , with 10 months of aftercare available . MAIN OUTCOME MEASURES Abstinence outcomes , treatment utilization , and costs 6 months after r and omization . RESULTS Both groups showed improvement on all drug and alcohol measures . Overall , there were no differences in total abstinence rates between the integrated care and independent care groups ( 68 % vs 63 % , P = .18 ) . For patients without SAMCs , there were also no differences in abstinence rates ( integrated care , 66 % vs independent care , 73 % ; P = .23 ) and there was a slight but nonsignificant trend of higher costs for the integrated care group ( $ 367.96 vs $ 324.09 , P = .19 ) . However , patients with SAMCs ( n = 341 ) were more likely to be abstinent in the integrated care group than the independent care group ( 69 % vs 55 % , P = .006 ; odds ratio [ OR ] , 1.90 ; 95 % confidence interval [ CI ] , 1.22 - 2.97 ) . This was true for both those with medical ( OR , 3.38 ; 95 % CI , 1.68 - 6.80 ) and psychiatric ( OR , 2.10 ; 95 % CI , 1.04 - 4.25 ) SAMCs . Patients with SAMCs had a slight but nonsignificant trend of higher costs in the integrated care group ( $ 470.81 vs $ 427.95 , P = .14 ) . The incremental cost-effectiveness ratio per additional abstinent patient with an SAMC in the integrated care group was $ 1581 . CONCLUSIONS Individuals with SAMCs benefit from integrated medical and substance abuse treatment , and such an approach can be cost-effective . These findings are relevant given the high prevalence and cost of medical conditions among substance abuse patients , new developments in medications for addiction , and recent legislation on parity of substance abuse with other medical benefits Objective : The objective of this study was to determine if receipt of revascularization  was similar among commercially insured adults with mental disorders compared with people without mental disorders . Methods : This was a retrospective analysis of a 100 % sample of Blue Cross/Blue Shield of Iowa administrative cl aims data , 1996 to 2001 . Logistic regression was used to calculate unadjusted and adjusted odds ratios ( OR ) for receipt of angioplasty ( PTCA ) and bypass graft surgery ( CABG ) within 30 days of discharge . Results : A total of 3368 adults , aged 18 to 64 years , were hospitalized for myocardial infa rct ion ( MI ) and 40 % ( n = 1342 ) had a mental disorder . Subjects with mental disorders were more likely to be younger , female , urban residents , and to have increased cardiovascular and medical comorbidity . They were similarly likely as subjects without mental disorders to have received PTCA ( OR , 1.10 ; 95 % confidence interval [ CI ] , 0.95–1.29 ) and CABG ( OR , 0.89 ; 95 % CI , 0.71–1.11 ) in analyses adjusted for demographic and clinical characteristics . Revascularization rates did not differ by mental disorder type , with few exceptions . Conclusions : Receipt of revascularization  was similar for patients with and without mental disorders . Our results may differ from previous findings as a result of the younger population studied and increased comorbidity in people with mental disorders , which may have result ed in a contraindication for surgical intervention . Conversely , the increased burden of comorbidity could suggest that these patients should have received PTCA at higher rates because of the better prognosis associated with revascularization as compared with medical management . Prospect i ve analyses with review of clinical data and behavioral risk factors are necessary to determine why some patients with mental illness may be less likely to receive cardiac interventions . MI = myocardial infa rct ion ; CVD = cardiovascular disease ; MHD = mental health disorders ; PTCA = percutaneous transluminal coronary angioplasty ; CABG = coronary artery bypass graft surgery ; CPT = Common Procedural Terminology ; ICD = International Classification of Diseases ; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition ; OR = odds ratio ; COPD = chronic obstructive pulmonary disease ; CI = confidence interval Abstract BACKGROUND : Persons with persistent mental illness are at risk for failure to receive medical services . In order to deliver appropriate preventive and primary care for this population , it is important to determine which chronic medical conditions are most common . OBJECTIVE : We examined chronic medical comorbidity in persons with schizophrenia using vali date d method ologies . DESIGN : Retrospective analysis of longitudinal administrative cl aims data from Wellmark Blue Cross/Blue Shield of Iowa . PARTICIPANTS : Subjects with schizophrenia or schizoaffective disorder ( N=1,074 ) , and controls ( N=726,262 ) who filed at least 1 cl aim for medical services , 1996 to 2001 . MEASUREMENTS : Case subjects had schizophrenia as the most clinical ly predominant psychotic disorder , based on psychiatric hospitalization , psychiatrist diagnoses , and outpatient care . Controls had no cl aims for any psychiatric comorbidity . Using a modified version of the Elixhauser Comorbidity Index , inpatient and outpatient cl aims were used to determine the prevalence of 46 common medical conditions . Odds ratios ( ORs ) were adjusted for age , gender , residence , and nonmental health care utilization using logistic regression . RESULTS : Subjects with schizophrenia were significantly more likely to have 1 or more chronic conditions compared with controls . Adjusted OR ( 95 % confidence interval [ CI ] ) were 2.62 ( 2.09 to 3.28 ) for hypothyrodisim , 1.88 ( 1.51 to 2.32 ) for chronic obstructive pulmonary disease , 2.11 ( 1.36 to 3.28 ) for diabetes with complications , 7.54 ( 3.55 to 15.99 ) for hepatitis C , 4.21 ( 3.25 to 5.44 ) for fluid/electrolyte disorders , and 2.77 ( 2.23 to 3.44 ) for nicotine abuse/dependence . CONCLUSIONS : Schizophrenia is associated with substantial chronic medical burden . Familiarity with conditions affecting persons with schizophrenia may assist programs aim ed at providing medical care for the mentally ill Background / Objective .Somatic health care utilization was studied among individuals with serious mental illness who were receiving community-based psychiatric services . Research Design .Cross-sectional study . SubjectsA total of 200 out patients , 100 with schizophrenia and 100 with affective disorder , were recruited from r and omly selected sample s receiving care at two psychiatric centers . Measures . Patients were interviewed using questions from national health surveys . Multiple logistic regression analyses were used to compare responses from each sample to those of matched subsets of individuals from the general population . Results .The psychiatric sample s were more likely to report receiving some medical care services in the past year than were individuals in the general population including having visited a general medical doctor ( Odds ratio , schizophrenia sample = 2.04 ; Odds ratio , affective disorder sample = 2.37 ) and having a complete physical examination ( Odds ratio , schizophrenia sample = 2.69 ; Odds ratio , affective disorder sample = 1.74 ) . However , our sample s were less likely to receive routine dental care  ( Odds ratio , schizophrenia sample = 0.46 ; Odds ratio , affective disorder sample = 0.60 ) . Perceived barriers to receiving medical care were reported significantly more often by the patient groups than the comparison groups ( Odds ratios > 3 ) . Conclusions . General health services are widely utilized by individuals with serious mental illness who are in outpatient psychiatric care . Dental services remain underutilized , however , and there is a high rate of perceived barriers to receiving medical care in this population OBJECTIVE In this secondary data analysis of Primary Care Research in Substance Abuse and Mental Health for the Elderly ( PRIMSe ) study , we hypothesized that older minorities who receive mental health services integrated in primary care setting s  would have greater service use and better mental health outcomes than older minorities referred to community services . METHOD We identified 2,022 ( 48 % minorities ) primary care patients 65 years and older , who met study inclusion criteria and had either alcohol misuse , depression , and /or anxiety . They were r and omized to receive treatment for these disorders in the primary care clinic or to a brokerage case management model that linked patients to community-based services .  Service use and clinical outcomes were collected at baseline , three months and six months post r and omization on all participants . RESULTS Access to and participation in mental health /substance abuse services was greater in the integrated model than in referral ; there were no treatment by ethnicity effects . There were no treatment effects for any of the clinical outcomes ; Whites and older minorities in both integrated and referral groups failed to show clinical ly significant improvement in symptoms and physical functioning at 6 months . CONCLUSIONS While providing services in primary care results in better access to and use of these services , accessing these services is not enough for assuring adequate clinical outcomes We determined whether patients with serious mental illness ( SMI ) were less likely than non-SMI to self-report having a medical condition that was recorded in their medical record . We included all patients from the VA National Psychosis Registry diagnosed with SMI and a r and om sample of non-SMI patients in fiscal year 1999 who completed the Large Health Survey of Veteran Enrollees ( N = 35,837 ) . Among patients with diagnoses for any of 11 conditions recorded in administrative data , we evaluated whether patients reported having that same condition in the survey , using multivariable logistic regression and generalized estimating equations . Among patients diagnosed with a given condition , those with SMI were less likely to report being told by providers that they had seven of the 11 conditions examined : heart disease ( OR = 0.68 , p < 0.001 ) , arthritis ( OR = 0.79 , p < 0.001 ) , cancer ( OR = 0.69 , p < 0.001 ) , diabetes ( OR = 0.79 , p < 0.001 ) , back pain ( OR = 0.81 , p < 0.001 ) , congestive heart failure ( OR = 0.71 , p < 0.001 ) , and hypertension ( OR = 0.77 , p < 0.001 ) . Patients with SMI were less aware of co-occurring medical conditions OBJECTIVE The aim of this study was to examine patterns of use of  general medical services  among persons with a severe and persistent mental illness enrolled in Medicaid from 1996 to 1998 . METHODS A total of 669 persons with a severe and persistent mental illness were identified by using statewide clinical criteria . A three-year data base of Medicaid cl aims was developed to examine service use . The main outcome measures were use of outpatient services for a general medical problem , use of dental and vision services , and use of screening tests for women .  Service use was examined by primary psychiatric diagnosis ( schizophrenic , affective , paranoid , and anxiety disorders ) , and analyses controlled for the presence of a chronic medical condition , age , race , and sex . RESULTS This study found high levels of service use for outpatient services but very low levels for primary and preventive services . Although 78 percent of persons with a schizophrenic disorder had an office-based visit during the three-year period , all persons with an anxiety disorder had such a visit . Sixty-nine percent of persons with a schizophrenic disorder had at least one emergency department visit , whereas 83 percent of those with an anxiety disorder had such a visit . Dental and vision visits and the use of mammograms and pap tests followed the same pattern ; persons with a schizophrenic disorder had fewer visits and had less overall use than the other diagnostic groups . The use patterns across the four groups were significantly different in outpatient service use , dental and vision service use , and screening tests for women . Compared with persons with a schizophrenic disorder , those with an anxiety disorder were more likely to have had an office-based visit and to have received vision services , those with a paranoid disorder were more likely to have used dental services or received a mammogram , and those with an affective disorder were more likely to have had a pap 
    Output:
    
Nevertheless , indirect evidence supports the observation that deficits in quality of care are contributing to higher than expected mortality in those with severe mental illness ( SMI ) and schizophrenia .
The quality of medical treatment provided to those with cardiac conditions and comorbid schizophrenia is often suboptimal and may be linked with avoidable excess mortality .