Use of Intra-aortic Balloon Pump in a Japanese Multicenter Percutaneous Coronary Intervention Registry

This problem is well illustrated in the study by Mangurian et al1 in this issue of JAMA Internal Medicine. The authors used CaliforniaMedicaiddatatoidentifypatientswhowereprescribed an antipsychotic medication. They then assessed what percentage of the patients had some form of glucose screening, a recommendation by the American Diabetes Association2 for persons taking antipsychotic medications, in a yearlong period. Overall, 30.1% of individuals were screened. It would be fair to point out that the efficacy of screening for diabetes has not been well established. However, that less than one-third had such screening for a known adverse effect of antipsychotic medication use suggests opportunities for improvement in integrated health care. Among those who had at least 1 primary care visit during the year, the proportion screened was significantly higher at 35.6% vs 19.8% for those who had no primary care visit. To improve care for persons with serious mental illness, it will be necessary to break down the silos that separate the mental health and physical health care systems. Integrated care (care provided by a team of physical and mental health clinicians)—or at least colocated care (care provided by physical and mental health clinicians in the same place)—offers the promise of improving the physical health of individuals with mental illness, as well as the mental health of those seeking physical health services.