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

This problem iswell illustrated in the study byMangurian et al1 in this issueof JAMAInternalMedicine. Theauthorsused CaliforniaMedicaiddatatoidentifypatientswhowereprescribed anantipsychoticmedication.Theythenassessedwhatpercentage of the patients had some form of glucose screening, a recommendation by the AmericanDiabetes Association2 for persons taking antipsychotic medications, in a yearlong period. Overall, 30.1%of individualswere screened. Itwouldbe fair to pointout that theefficacyofscreening fordiabeteshasnotbeen well established. However, that less than one-third had such screening for a knownadverse effect of antipsychoticmedicationuse suggests opportunities for improvement in integrated health care. Among thosewhohad at least 1 primary care visit duringtheyear, theproportionscreenedwassignificantlyhigher at 35.6% vs 19.8% for thosewho 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 mentalhealthandphysicalhealthcaresystems. Integratedcare (care provided by a team of physical andmental health clinicians)—orat least colocatedcare (careprovidedbyphysical 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.