Table 2 Elements of effective mental health integrated care models in primary care settings and their outcomes
Reference, Country Study type | Model/study name | Aim and sample characteristics | Elements of the model | Reported outcomes |
|---|---|---|---|---|
Bartels, Coakley [34], USA Randomized Controlled Trial Ayalon, Arean [33], USA Site specific analysis | Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISM-E) study | Bartels et al., (2004) aimed to test whether relative to the control, the integrated model of care would result in better access to and utilization of Mental health /substance use services in both black and white older adults (> 65 years) Ayalon et al., (2007) examined data from 1 of the sites from this trial to compare engagement and participation rates in black and white elderly | Co-location Licensed mental health clinicians Communication between providers Timely cross appointments | Integrated care was associated with more mental health and substance abuse visits per patient Persons with more severe depression and more severe problem drinking showed greater engagement Patients were more likely to have first appointments with mental health and substance abuse care provider within 2 weeks of the primary care visit Integrating mental health/substance abuse services were particularly effective in engaging black elderly in mental health/substance abuse services |
Areán, Ayalon [35], USA Randomised Controlled Trial | Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) study | To test whether depressed older adults from the 2 largest ethnic minority groups (black and Latino) benefited similarly from CC for depression in primary care as did whites | Patient education Co-located mental health professional Ongoing depression monitoring Regular specialist consults | By the 12-month assessment period, older minorities who received CC used far more guideline concordant depression services (antidepressant medications or psychotherapy) Older minorities who received CC had significantly better depression outcomes, significantly higher rates of treatment response, and significantly higher rates of remission than minorities in usual care (UC) Blacks who received CC had substantially better functional outcomes than did blacks in UC Provision of services in a nonmental health setting, such as primary care medicine addresses stigma and trust barriers Older minorities tend to be wary of the mental health system and are more likely to seek services from their primary care physician |
Gensichen, von Korff [36], Germany, Cluster randomised controlled trial | PRimary care Monitoring for depressive Patients Trial (PRoMPT) | To test whether case management by a practice-based health care assistant (HCA) can reduce depression symptoms and improve the process of care for adult patients with major depression in small primary care practices. HCAs have less training than U.S. physician assistants or nurse practitioners. In Germany, HCAs have 3 years of on-the-job training. They are mainly responsible for administrative tasks in general practice but provide basic clinical procedures | Training Case management Encouragement for self-management Communication with family physician | This is a simple, depression case management intervention in non-academic, non-structured, small primary care practice settings Patients who received telephone case management by HCAs reported slightly greater improvements in depression symptoms, better adherence to antidepressant therapies, and more favourable assessments of the quality of their care than did patients randomly assigned to receive usual care The practice teams’ familiarity with their patients and long-time continuity of the patient–provider relationships, which are typical for small primary care practices, may have played a role in achieving the positive results |
Huijbregts, de Jong [37], Netherlands, Cluster randomized controlled trial | Effectiveness of the IMPACT model in primary care in the Netherlands | To test whether the IMPACT collaborative care model developed in the USA could be applied for adults (> 17 years) in small, individual practices such as those found in the Netherlands | Multidisciplinary team Standard treatment intervention Target driven treatment Use of a web-based decision aid with stepwise algorithm Consultation by a psychiatrist | CC care was more effective in achieving treatment response than CAU at three months for the total group of patients who received collaborative care. The effect was not statistically significant at 6 and 12 months The effect of CC, particularly for the screened group, subsided to a certain extent after twelve months, which might be explained by the fact that the intensity of the intervention was toned down at this point The treatment response and remission in the usual care group was very low (the response percentages ranged between 10.5% and 25.8%). ‘Depression’ may not have been on the patients’ agenda in their contacts with primary care in the CAU-condition, as these cases were detected by means of screening |
Chang-Quan, Bi-Rong [38], China, Systematic review of randomized controlled trials | Collaborative Care Interventions (CCI) for Depression in the Elderly | To determine the effective components and the feasibility of CCIs in the treatment of depression in older patients Participants–Pool A studies 1801 primary care patients aged 60 and older with major depression, dysthymia, or both from 18 primary care clinics in 8 US health care organizations Excluded criteria: current drinking, problems, bipolar disorder or psychosis, severe cognitive impairment, acute risk of suicide, or ongoing psychiatric treatment Participants—Pool B studies 598 primary care patients aged 60 and older with depression from 20 primary care practices in New York City, Philadelphia, and Pittsburgh regions Excluded criteria: current drinking, problems, bipolar disorder or psychosis, severe cognitive impairment, acute risk of suicide, or ongoing psychiatric treatment | Interventions—Pool A studies Collaborative Care Intervention (IMPACT) Intervention—Pool B studies Prevention of Suicide in Primary Care Elderly (PROSPECT) | CCIs significantly decrease suicide ideation compared to those receiving usual care CCIs significantly increased depression-free days, but did not significantly increase outpatient cost Collaborative care interventions with communication between primary care providers and mental health providers were no more effective in improving depression symptoms than CCIs without such communication |