Randomized Clinical Trial of the Effectiveness of a Home-Based Advance Practice Psychiatric Nurse Intervention

Navigating the health care system can be difficult for anyone. Trying to coordinate visits with multiple specialists and ensure that a primary care doctor has all the information she or he needs to provide appropriate care can be taxing under the best of circumstances. When the person attempting to navigate the system also struggles with severe mental illness, the obstacles can be insurmountable.

A study co-led by Nancy Hanrahan, R.N., Ph.D., a professor at the University of Pennsylvania School of Nursing and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar, concludes that having an advanced practice psychiatric nurse (APRN) oversee and organize care can help improve care and quality of life of these patients. The study was published in the May 2011 of Nursing Research and Practice.

The researchers found that when APRNs were highly involved in overseeing the community-based care of people with both serious mental illness and HIV, those patients had significant reductions in symptoms. The APRNs provided education and medication management and acted as advocates for their patients, helping to ensure coordinated care.

“Individuals with serious mental illness generally have difficulty socializing, planning and organizing—skills that are crucial for navigating the health care system,” Hanrahan said. “Patients who also have HIV and must navigate more than one system need help to ensure that they receive high quality care and appropriate services. That help is best provided by a health care professional who has the training and background to coordinate care and ensure proper communication and social supports.”

The study, conducted in Philadelphia, included a control group and an intervention group of patients. APRNs provided home-based services to patients in the intervention group over the course of a year. Patients who had the highest levels of interaction with nurses (regular face-to-face meetings) had the best outcomes. The APRNs worked with clients’ case managers, boarding homes, shelters, pharmacies and clinical providers to clarify, coordinate and manage treatment regimens, and to help patients overcome any barriers to accessing or receiving the care they needed.

The study’s other principal investigators were Linda H. Aiken, Ph.D., F.A.A.N., F.R.C.N., R.N., Clair M. Fagin Leadership professor of nursing, professor of sociology and director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania; Michael B. Blank, Ph.D., associate professor of psychology in psychiatry, Center for Mental Health Policy, School of Medicine at the University of Pennsylvania;