NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Butler M, Kane RL, McAlpine D, et al. Integration of Mental Health/Substance Abuse and Primary Care. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Oct. (Evidence Reports/Technology Assessments, No. 173.)
This publication is provided for historical reference only and the information may be out of date.
Project Name or 1st Author, Year, Study Design | Study Aim | Study Period | Patient Population | Settings | Outcomes Measured |
---|---|---|---|---|---|
Depression Disorders | |||||
Fortney, 2007
1,
2
RCT Randomized by matched site | Assess telemedicine - based collaborative care vs. usual care to improve depression care at small clinics without on-site psychiatrists. | Recruitment 2003. Study period 12 months. | Current VA patients diagnosed with depression. 92%
male, 75% white, mean age 59. Control N=218 Intervention N=177 | 7 rural VA community-based outpatient clinics with no on-site psychiatry or psychology in AK, MS, LA. | Depression symptoms, remission, treatment response, adherence. Physical, mental quality of life, wellbeing, and patient satisfaction. Model fidelity. |
PRISM-E (for depression)
3
–
5
RCT Randomized by patient | Assess integrated vs. enhanced referral care for improving depression outcomes in elderly patients. | Recruitment March 2000 to March 2002. Study period 6 months | Elderly primary care patients: 31% female, 55%
non-white, mean age 74 Integrated N=758 Referral N=773 | 10 practices with 34 urban, suburban, and rural clinics. 5 VA, 3 community health, 2 hospital networks in the Northeast, Miami, and Chicago | Depression symptoms, remission, MH QoL. Program use. |
Geron, 2006
6
RCT | Assess social worker care manager vs. usual care for depressed home-dwelling frail elderly | Study period 12 months. Recruitment period not completed. | Current patients over 65 years with 2 or more chronic medical conditions, ER visit or hospital admission in past 6 months | An MCO urban primary care clinic. | Depression symptoms, satisfaction, QoL, adverse health outcomes, physical function, utilization, cost |
Grypma, 2006
7
Cohort | Assess adapted version of IMPACT post trial vs. usual care on depression care for adults. | Study period 12 months. IMPACT study period 1999-2001. Post-trial data from 2002-2004. | Current adult patients. 8.4% male, average age 63, 63%
above 60 years RCT controls N=116 Post-study intervention N=95 | 2 Kaiser Permanente practices in San Diego area | Depression symptoms, utilization |
IMPACT
8
–
12
RCT Randomized by patient | Assess collaborative care vs. usual care on depression care for elderly. | Recruitment July 1999 to August 2000. Intervention 12 months. Study period 2 years. | Current patients 60+ years old with depression. 65%
female, 77% white, Control N=895 Intervention N=906 | 7 national sites in Indiana, Texas, Washington, and California. Rural and urban. Group and academic practices, and VA. | Depression symptoms, treatment response, remission, patient self-efficacy, function and QoL, satisfaction, antidepression medication use, treatment utilization |
Clarke, 2005
13
RCT Randomized by patient | Assess collaborative care with CBT vs. usual care for depressed HMO pediatric primary care patients. | Recruitment March 2000 to November 2001. Study period 1 year. | Pediatric patients age 12–18 years old in a
current major depression episode. Average age 15, 77% female, 14%
non-white. Control N=75 Intervention N=77 | HMO pediatric clinic in Portland, OR, part of Kaiser Permanente | Depression symptoms, relapse, QoL, satisfaction, utilization |
PROSPECT
14
–
16
RCT Randomization by matched sites | Assess guideline based depression recognition and treatment program vs. usual care for elderly patients to prevent and reduce suicidal behavior | Recruitment May 1999 to August 2001. Study period 2 years | English speaking patients over 60 years with major
depression. 31% above age 75, 72% female, 32%
non-white. Control N=278 Intervention N=320 | 18 clinics in New York, Pennsylvania, and Pittsburgh. Group, university affiliated, and solo practices in urban, suburban, and rural locations. | Depression symptoms, treatment response, and remission, utilization |
Pathways
17,
18
RCT Randomized by patient | Assess collaborative care vs. usual care for adult diabetes patients with depression | Recruitment April 2001 to May 2002. Intervention 12 months. Study period 2 years | English speaking adult diabetes patients with major
depression. Average age 58, 65% female, 81% white. Control N=165 Intervention N-165 | 9 HMO clinics within 40 mile radius of Seattle. | Depression symptoms, diabetes outcomes and self-care, functional and QoL, adherence and utilization, cost-effectiveness. |
RESPECT-D
19,
20
RCT | Assess evidence-based model of depression management vs. usual care for adult patients with depression | Recruitment February 2002 to February 2003. Patient study period 6 months. | English speaking patients 18 years or older starting
treatment for major depression. Average age 42, 80% female, 17%
non-white. Control N=181 Intervention N=224 | 3 medical groups and 2 health plans across U.S., each with at least 10 PC practices and established QI programs. 60 practices, matched and randomized. | Depression symptoms, treatment response, remission, utilization |
Simon, 2004
21
RCT Randomized by patient | Assess telephone care management and telephone care management plus psychotherapy vs. usual care for adult patients with depression. | Recruitment November 2000 to May 2002. Study period 6 months. | Adult patients beginning antidepressant treatment.
Average age 44, 74% female, 79% white Control N=195 Telephone care N=207 Telephone care + psychotherapy N=198 | 7 urban and suburban HMO clinics in Washington State. | Depression symptoms, remission, adequate pharmacotherapy. |
Adler, 2004
22,
23
RCT Randomized by patient | Assess pharmacist adherence management vs. usual care for adult patients with depression. | Study period 6 months. Recruitment not reported. | English speaking adults with major depression. Average
age 42, 72% female, 72% white. Control N=265 Intervention N=268 | 9 group practice clinics in Boston area, with 5 clinics at an academic medical center. | Depression symptoms, antidepressant utilization and adherence. |
Finley, 2004
24
RCT Randomized by patient | Assess collaborative care with pharmacist care manager vs. usual care for adults with depression. | Study period 6 months. Recruitment not reported | Adult patients beginning antidepressant treatment.
Average age 54, 85% female. Control N=50 Intervention N=75 | HMO clinic in San Rafael, CA. | Depression symptoms, treatment response, remission, change in disability, adherence and utilization, cost. |
Swindle, 2003
25
RCT Randomized by patient | Assess collaborative care with MH clinical nurse care manager vs. usual care for veterans with depression | Study period 12 months. Recruitment not reported. | Community dwelling adult patients with depression. 97%
male, 85% white. Control N=134 Treatment N=134 | 2 Indianapolis VA clinics, randomized by site. | Depression symptoms, utilization, cost. |
Partners in Care
26
–
30
RCT Randomized by site | Assess quality improvements in medication management and therapy vs. usual care for adults with depression | Intervention 6 months. Study period 2 years. Recruitment not reported. | English or Spanish speaking adult patients with
depression. Average age 44, 71% female, 30% Hispanic. Control N=430 QI Meds N=405 QI Therapy N=464 | 6 MCOs representing geographically diverse regions in U.S., with 46 clinics. | Depression symptoms, QoL, employment, utilization, overall poor outcome (constructed measure) |
Datto, 2003
31
RCT Randomized across sites | Assess telephone-based depression management for acute phase depression vs. usual care for adult patients. | Study period 16 weeks. Recruitment not reported. | Patients with depression. Average age 48, 61% female,
80% white. Control N=31 Intervention N=30 | 35 urban and suburban clinics in Pennsylvania. | Depression symptoms, QoL, clinician and patient adherence. |
Hedrick, 2003
32
RCT Randomized across sites | Assess collaborative care vs. usual consult-liaison care for VA patients with depression. | Study period 9 months. Recruitment January 1998 to March 1999. | Current patient with major depression, dysthymia, or
both. Average age 57, 95% male, 80% white. Control N=186 Intervention N=168 | 4 clinics in Seattle division of VA-Puget Sound. | Depression symptoms, treatment response, remission, QoL, medication utilization. |
Katon, 1995
33
RCT Randomized by patient | Assess collaborative care vs. usual care for adult patients with depression. | Study period 12 months. Intervention period up to 9 months. Recruitment not reported. | English speaking, current adult patients beginning
antidepressants. Average age 48, 76% female. Control N=109 Intervention N=108 | Northgate Medical Center, Group Health Cooperative HMO in western Washington state, a family physician clinic. | Depression symptoms, disability, medication adherence, satisfaction, utilization |
Katon, 1999
34
RCT Randomized by patient | Assess stepped collaborative care vs. usual care for adult patients with depression. | Study period 6 months. Recruitment not reported. | English speaking, current adult patients beginning
antidepressants. Average age 47, 75% female, 80%
white. Control N=114 Intervention N=114 | 4 Group Health Cooperative HMO clinics in Seattle area. | Depression symptoms, disability, medication adherence, costs |
Katon, 1996
35
RCT Randomized by patient | Assess collaborative care vs. usual care for adult patients with depression. | Study period 6 months. Recruitment not reported. | English speaking, current adult patients beginning
antidepressants. Average age 46, 74% female, 87%
white. Control N=76 Intervention N=77 | Northgate Medical Center, Group Health Cooperative HMO in western Washington state, a family physician clinic. | Depression symptoms, disability, medication adherence, costs |
Katon, 2001
36,
37
RCT Randomized by patient | Assess collaborative care vs. usual care for adult patients at risk for depression relapse | Study period 12 months. Recruitment not reported. | English speaking, current adult patients beginning
antidepressants. Average age 46, 73% female, 90%
white. Control N=192 Intervention N=194 | 4 Group Health Cooperative HMO clinics in Seattle area. | Depression symptoms, depression relapse, medication adherence |
Capoccia 2004
38,
39
RCT Randomized by patient | Assess pharmacist based collaborative care vs. usual care for adults with depression | Recruitment from November 1999 to March 2001. Study period 12 months. | English speaking current adult patients beginning
antidepressants. Average age 39, 57% female, 22%
non-white. Control N=33 Intervention N=41 | Academic family practice clinic in Seattle. | Depression symptoms, QoL, medication adherence, utilization, cost. |
Tutty, 2000
40
Cohort | Assess telephone counseling and medication monitoring for adult patients with depression. | Study period 6 months. Recruitment not reported. | Adult patients beginning antidepressants. Average age
47, 69% female. Control N=94 Intervention N=28 | One Group Health Cooperative clinic in Olympia. | Depression symptoms, treatment response, remission, adequate dosage. |
Hunkeler 2000
41
RCT Randomized by site | Assess nurse telehealth care vs. usual care for adults with depression. | Study period 6 months. Recruitment not reported. | English speaking adults with SSRI prescription for
depression. About 70% female, 37% non-white. Control N=123 Intervention N=179 | 2 Kaiser Permanente clinics in northern CA. | Depression symptoms, treatment response, QoL, adherence. |
QuEST
42
–
44
RCT Randomized by matched site | Assess guideline based depression treatment program vs. usual care for adult patients with depression. | Recruitment from April 1996 to September 1997. Study period 2 years. | English reading current adult patients with depression.
Average age 43, 84% female, 16% non-white. Control N=240 Intervention N=239 | 12 practices across U.S. Urban and rural. | Depression symptoms, QoL, guideline concordant care. |
Simon, 2000
45
RCT Randomized by patients | Assess feedback only or feedback plus care management vs. usual care for adult patients with depression. | Study period 6 months. Intervention period 4 months. Recruitment period not reported. | Current adult patients newly prescribed
antidepressants. Average age 46 years, 72% female. Control N=196 Feedback only N=221 FB and care mgmt N=196 | 5 HMO primary care clinics in Washington state | Depression symptoms, treatment response, remission, adequate dosage, cost |
Hilty, 2007
46
RCT Randomized by patient | Assess usual care depression management with telepsychiatric and PCP training vs. usual care depression management for adult patients with depression. | Study period 1 year. 2 year recruitment, period not reported. | English speaking current adult patients with depression
willing to take antidepressants. Median age 46, 80% female, 10%
non-white. Control N=41 Intervention N=52 | 8 rural primary care clinics, average 140 miles from UC Davis Medical Center. | Depression symptoms, functioning and QoL, satisfaction. |
Katzelnick, 2000
47
RCT Randomization across sites by physician practices | Assess depression management vs. usual care for high utilizers with depression, not in active treatment | Study period 12 months. Recruitment period not reported. | Current adult patients above 85th percentile
in utilization for previous 2 years. Average age 45, 77% female, 83%
white Control N=189 Intervention N=218 | 3 HMOs in the Midwest, Northwest and New England regions, 163 primary care practices. | Depression symptoms, treatment response, remission, functioning and QoL, utilization |
Anxiety Disorders | |||||
Roy-Byrne, 2001
48
RCT Randomized by patient | Assess collaborative care vs. usual care for adult patients with panic disorder. | Study period 12 months. Recruitment not reported. | English speaking adult patients with at least one panic
attack in last month. Average age 41, 57% female, 67%
white. Control N=58 Intervention N=57 | 3 urban and suburban group practice clinics in Seattle area, 2 are university associated. | Panic, anxiety, and depression symptoms, treatment response, remission, QoL, appropriate medication and dosage, adherence. |
CCAP
49,
50
RCT Randomized by patient, stratified within site | Assess collaborative care vs. usual care for adults with panic disorder. | Recruitment March 2000 to March 2002. Study period 1 year. | English speaking adult patients with at least one panic
attack within last week. Average age 41, 67% female, 66%
white Control N=113 Intervention N=119 | University affiliated primary care clinics in Seattle, San Diego, and Los Angeles | Remission, treatment response, anxiety sensitivity, depression symptoms, QoL and functional disability, utilization |
CALM
51
RCT Randomized across sites | Assess collaborative care vs. usual care for adult patients with anxiety disorders, including GAD, PTSD, PD, and SAD | Study period 18 months. Recruitment not complete | English speaking adult current patients with GAD, PTSD,
PD and SAD, N to be1040, 260 at each site | Seattle, WA, Los Angeles and San Diego, CA, and Little Rock, AK | Anxiety disorder symptoms, functioning and QoL, satisfaction, utilization. Design only. No results yet |
Rollman, 2005
52,
53
RCT Randomized by patients | Assess telephone-based collaborative care vs. usual care for adult anxiety and panic disorder patients. | Recruitment July 2000 to April 2002. Study period 12 months | English speaking, adult current patients with anxiety
disorders. Average age 44 years, 81% female, 95%
white. Control N=75 Intervention N=116 | 13 PCPs in Pittsburgh area, urban academic, suburban, and rural. | Anxiety disorder symptoms, depression symptoms, QoL, utilization, employment status |
Price, 2000
54
Matched Cohort | Assess integrated care vs. usual care for adult patients with generalized anxiety disorder (GAD) and GAD secondary to depression. | Study period 6 months. Recruitment not reported | English speaking, adult current patients with GAD. Mean
age 49 years, 80% female, 86% white. Control N=111 Intervention N=113 | Kaiser Permanente clinics in Westminster, CO. Intervention patients family practice, control patients internal medicine | Anxiety symptoms, satisfaction |
Other | |||||
Katon, 1992
55
RCT Randomized by patients, stratified by physician and blocked | Assess effect of psychiatric consultation vs. usual care for distressed high utilizers of medical care. | Study period 12 months. Recruitment not reported. | Top 10% adult ambulatory care utilizers of appropriate
age group with psychiatric distress. Average age 47, 61%
female. Control N=127 Intervention N=124 | 2 primary care clinics of Group Health Cooperative of Puget Sound. | Psychiatric distress, functional disability, utilization, use of and adherence to antidepressants |
Epstein, 2007
56
RCT Randomized by pediatricians | Assess collaborative care consultative service for titration and monitoring vs. usual care to improve ADHD care. | Study period 1 year. Recruitment not reported. | 1st through 5th grade children
with ADHD Control N=215 Intervention N=162 | 12 community-based pediatric practices without onsite psychiatry or psychologist. | ADHD symptoms. Titration trials, medication management, dosage, adherence |
PRISM-E (for at-risk alcohol use)
4,
5,
57
RCT Randomized by patients | Assess integrated vs. enhanced referral care for managing at-risk alcohol use in elderly patients | Recruitment March 2000 to March 2002. Study period 6 months (on-going) | Elderly primary care patients. 92% male, 70% white,
mean age 72 Intervention N=280 Referral N=280 | 9 practices with 34 urban, suburban, and rural clinics. 5 VA, 2 community health, 2 hospital networks in the Northeast, Miami, and Chicago | Drinking severity, MH QoL, Program use. |
Backward Integration | |||||
Weisner, 2001
58,
59
RCT Randomized by patients | Assess integrated vs. usual care for medical and substance abuse care | Recruitment April 1997 to December 1998. Study period 6 months | Adult patients admitted to a
chemical dependency program. Mean age 37, 55% male, 74%
white. Control N=307 Intervention N=285 | Kaiser Permanente's Chemical Dependency Recovery Program, southern CA | Abstinence, treatment utilization. No primary care outcomes |
Druss, 2001
60
RCT Randomized by patients Willenbring, 1999 61 RCT Randomized by patients | Assess integrated medical health care vs. usual care for patients with serious mental illness | Study period 12 months. Recruitment not reported. | VA mental health patients without
a current primary care provider. Mean age 45, 99% male, 70%
white Control N=61 Intervention N=59 | West Haven, CT, VAMC | Utilization, quality of preventive care, satisfaction, physical and mental health status, costs |
Assess integrated outpatient treatment vs. usual care for alcohol-related medically ill alcohol abuse patients | Study period 2 years. Recruitment period not reported. | VA patients with current alcohol abuse behavior and
alcohol-related medical illness. Mean age=55.1 Control N=53 Intervention N=48 | Minneapolis, MN VA medical center | Drinking severity, quality of life, utilization |
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- Appendix E: Evidence Table - Integration of Mental Health/Substance Abuse and Pr...Appendix E: Evidence Table - Integration of Mental Health/Substance Abuse and Primary Care
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