Table 3: Evidence based interventions related to integrated care 2009-2014 by setting type.

Behavioral Health into Primary Care
Author Intervention Design Sample Findings/Outcomes
Alexopoulos et al. [20] PROSPECT: Care management intervention
15 trained care managers offered physician algorithm-based recommendations & helped with treatment compliance
RCT (n=599) 60 years or older; had minor or major depression; suicidal ideation; seen in primary care.
  • Intervention group more likely to: be prescribed antidepressants or psychotherapy; have 2.2 times greater decline in suicide ideation than usual care.
  • Intervention group patients with major depression: more attained remission than usual care & sustained through 24 month (45.4% vs 31.5%).
  • No difference in patients with minor depression, both groups with favorable outcomes.
Echeverry et al. [21] Antidepressant use in minority population with uncontrolled diabetes to improve HgA1c and QOL RCT double bind placebo control (n = 89; 75 completed) HgA1c levels of < 8% and depression
  • Sertraline group significantly greater decrease in HgA1c and systolic blood pressure levels (P=0.45[P<10-6]) compared with placebo.
  • No significant difference in QOL
Hay et al. [22] Collaborative depression care program among low-income Hispanics with diabetes.
(Multifaceted Diabetes and Depression Program)
RCT (n=387) (96.5% Hispanic) with diabetes and clinically significant depression
  • Intervention significantly greater health improvement compared with controls over 18-month evaluation period (4.8%; P < 0.001) and corresponding significant improvement in depression-free days (43.0; P < 0.001).
  • Medical cost differences were not statistically significant.
Szymanski et al. [23] Compare primary care services (PC) only with receiving primary care and mental health integration interventions (PC-MHI) or specialty mental health interventions (SMI) Retrospective Chart Review (n = 36, 263)
Veterans in primary care setting
  • Patients who received same-day PC-MHI services were more likely to begin treatment, be it psychotherapy (OR: 8.16; 95 % CI: 6.54-10.17) and/or antidepressant medications (OR: 2.33, 95 % CI: 2.10 -2.58) within 12 weeks than those who received only PC services on screening days.
Primary Care into Behavioral Health
Author Intervention Design Sample Findings/Outcomes
Druss et al.
[24]
Tested population-based medical care management intervention (care managers, health education and support) designed to improve primary medical care in community mental health settings. RCT (n = 427)
Persons in a community mental health setting
Intervention group receiving significantly higher proportion of:
  • Recommended preventive services (58.7% versus 21.8%);
  • Evidence based services for cardiometabolic conditions (34.9% versus 27.7%);
  • Primary care providers (71.2% versus 51.9%)
  • Improvement on the SF-36 (8.0% versus 1.1% decline in usual care group).
McGuire et al. [25] Clinic integrating homelessness, primary care and mental health services Quasi exper-imental (n = 130) Veterans homeless with serious mental illness or substance abuse
  • Integrated care group was more quickly enrolled in primary care and had significantly higher number of primary care visits (on average 2.3 visits more) than usual care group
  • Individuals with more prevention services and primary care visits had fewer emergency department visits
  • No difference in inpatient utilization or in physical health status when measured over 18 months.

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