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J Gen Intern Med. 2002 Jul;17(7):556-60.

Receipt of nutrition and exercise counseling among medical outpatients with psychiatric and substance use disorders.

Author information

  • 1Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, Conn 06516, USA. mayur.desai@yale.edu

Abstract

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.

PMID:
12133146
[PubMed - indexed for MEDLINE]
PMCID:
PMC1495079
Free PMC Article
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