Results Summary
What was the research about?
People who have a serious mental illness, or SMI, are at higher risk for other health problems. An SMI, such as depression or bipolar disorder, may make it hard for people to work or live on their own or to arrange for health care. These problems can be worse if language or cultural issues are barriers to receiving care.
In this study, the research team compared two types of care. The first type was integrated care. Integrated care includes both physical and mental health care at the same clinic. The second type was integrated care with a peer navigator. Peer navigators have backgrounds similar to patients and help patients find and use healthcare services. The team looked to see how well these two types of care worked to help Latinx patients with an SMI get the care they need.
What were the results?
Compared with Latinx patients who didn’t work with a peer navigator, patients who did reported
- More scheduled doctors’ visits
- Going to more of their scheduled doctors’ visits
- Having more improvement in their mental health
- Feeling more in control of their health
- Having better quality of life
Latinx patients who didn’t work with a peer navigator and patients who did reported similar physical health.
Who was in the study?
The study included 110 Latinx patients with an SMI in the Chicago area. Of these, 66 percent had depression, 21 percent had an anxiety disorder, 7 percent had bipolar disorder, 3 percent had schizophrenia, and 2 percent had posttraumatic stress disorder. In addition, 63 percent preferred to speak Spanish, and 72 percent were born outside of the United States. The average age was 46, and 58 percent were women. All patients received care at a health clinic that offered physical and mental health care in the same place.
What did the research team do?
Before the study, peer navigators completed 20 hours of training. They continued to receive more training and supervision during the study.
The research team assigned patients by chance to one of two groups. One group received integrated care. The other group received integrated care and worked with a peer navigator. For one year, the navigators
- Talked with patients by phone once a week
- Helped patients work with doctors and get the health care they needed
- Answered patients’ questions
- Talked to patients about their health goals
- Helped patients get access to community resources and services
To see how many doctors’ visits the patients scheduled and went to, the research team called all patients every week. Patients filled out health surveys at the beginning of the study and 4, 8, and 12 months after the study started.
During the study, Latinx patients with an SMI, a health researcher with a mental illness, a Latinx public health professional, and local health center staff worked with the research team.
What were the limits of the study?
The study included a small number of patients living in one area. Results may differ for people who live in different areas. Most patients had either depression or anxiety disorder. Results may be different for Latinx people with other types of SMI. The research team got information about patients’ SMI from the patient, not their doctor. Information provided by the doctor might differ.
Future studies could include more patients from other locations or with different SMI diagnoses.
How can people use the results?
Clinics that offer integrated care might use these results to decide if they want to have peer navigators work with Latinx patients with SMI. Patients can use these results to help decide if they want to work with a peer navigator if one is available at their clinic.
Professional Abstract
Objective
To compare the effect of peer navigators to existing integrated services on primary care service engagement of Latinx patients with serious mental illness (SMI)
Study Design
| Design Elements | Description |
|---|---|
| Design | Randomized controlled trial |
| Population | 110 adult Latinx patients with SMI |
| Interventions/ Comparators |
|
| Outcomes |
Primary: service engagement Secondary: physical illness, recovery, personal empowerment, quality of life |
| Timeframe | 1-year follow-up for primary outcome |
This randomized controlled trial measured the effect on service engagement for Latinx patients with SMI, receiving peer support as well as integrated primary medical and behavioral healthcare services versus integrated services alone. Both interventions addressed the elevated rates of co-morbidities among people with SMI that add to this population’s disability and lower life expectancy, which is further exacerbated by racial and ethnic health disparities.
The research team recruited 110 Latinx patients with SMI in the Chicago area. Of these, 66% had a diagnosis of major depression, 21% had anxiety disorder, 7% had bipolar disorder, 3% had schizophrenia, and 2% had posttraumatic stress disorder. In addition, 63% of patients’ preferred language was Spanish, and 72% were born outside the United States. The average age was 46, and 58% were female.
Researchers randomly assigned patients to receive either integrated care alone or integrated care plus support from a peer navigator. Peer navigators were full-time, provider-agency employees in recovery from SMI who were from the same ethnic group as patients. They partnered with patients in day-to-day tasks to help them better engage in, and benefit from, health care. Peer navigators completed 20 hours of training before the study and received more training and supervision from the team during the study.
Patients receiving support from peer navigators met with them one-on-one weekly via telephone for one year. Support included answering patient questions, discussing health priorities and wellness goals and helping patients meet them, and supporting patients in accessing community resources and entitlement programs.
Through weekly phone calls, all patients reported appointment data to the research team. Patients also completed surveys on health outcomes at baseline and at 4, 8, and 12 months.
Six Latinx patients with SMI, a health services researcher with lived mental illness experience, a Latinx public health professional, and a service provider from a local community health center worked with the research team on all aspects of the study.
Results
Over a one-year period, patients in both groups scheduled more appointments over time (p=0.03); however, patients receiving peer-navigator support reported more scheduled appointments and more completed appointments (p<0.05) than patients receiving integrated care alone.
Compared with patients receiving integrated care alone, patients receiving peer-navigator support had greater recovery from mental illness (p<0.001) and greater empowerment (p<0.05) and quality of life (p<0.05). The two groups did not differ in perceived physical health.
Limitations
The study included a relatively small group of participants in a single area. Findings may not be generalizable to a larger, more diverse group of Latinx patients. In addition, more than 80% of patients reported having a diagnosis of either major depression or anxiety disorder; results may not be generalizable to people with other SMIs. The research team relied on patient self-report of SMI.
Conclusions and Relevance
The peer-navigator program demonstrated a positive impact on making and keeping appointments for primary medical care among Latinx patients with SMI. It also demonstrated improvements in recovery from mental illness and in improved empowerment and quality of life.
Future Research Needs
Future research could focus on comparing the peer-navigator program with integrated care in a larger, more geographically diverse sample of participants, as well as with patients with varied SMI diagnoses.
Final Research Report
View this project's final research report.
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In a blog post, two patient partners from PCORI-funded projects discuss their personal experiences and their projects' findings that integrating peer navigators into routine care can improve the physical health of patients with serious mental illness.
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Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented, and the researchers made changes or provided responses. Those comments and responses included the following:
- Reviewers noted that the report describes the patient population under study as having serious mental illness. They also stated that for most readers serious mental illness would indicate the more severe and less common mental illnesses, like bipolar disorder and schizophrenia. However, most of the patient sample had depression or anxiety, which are more common mental illnesses. The researchers clarified that they determined study eligibility more by functional disability—as reported by the patient—than by a specific diagnosis.
- Reviewers expressed concern that researchers ascertained the primary outcomes, scheduled appointments and achieved appointments, through patient self-reporting and not through more objective means, like the patients’ medical records. Reviewers further noted that participants in the peer navigation program might have more incentive to overestimate the number of their appointments because they felt more accountable to their peer navigators. The researchers acknowledged this concern with a statement in the study limitations section.
- Reviewers noted that the data did not support the conclusion that study participants in the peer navigator program had more achieved appointments than participants in the integrated care program, despite the significant interaction term in the multivariable analysis. The results instead seemed to indicate a positive trend in achieved appointments for the integrated care group rather than for the peer navigator program group. In response, the researchers added a statement to the results indicating that post-hoc analyses failed to show that the significant interaction resulted in a greater increase in achieved appointments for either condition.