Table 9Clinical outcomes by level of integrated proactive process of care

Outcome Project or AuthorMeasurementPatient CategoryAssessment PeriodDirection of EffectEffect SizeComment
MENTAL ILLNESS SYMPTOMS (SEVERITY)
High Level (Depression)
Price, 2000 91 Shedler Quick Psycho Diagnostics Panel (Anxiety)6 monthsInterventionP=.046
Hedrick, 2003 87 SCL-20 3 monthsIntervention-0.17, 95% CI -0.31; -0.03, p<.05Equalized amount of treatment between collaborative and consult-liaison models; attention control
9 monthsNS
IMPACT 2, 179 SCL-20 3 monthsIntervention-0.28, 95% CI -0.34; -0.21, p<.001
6 monthsIntervention-0.28, 95% CI -0.35; -0.19, p<.001
12 monthsInterventionNNT=4
18 monthsInterventionNNT=6
24 monthsInterventionNNT=9
Grypma, 2006 93 PHQ-9 scoreAll depression patients6 months NSIMPACT intervention group compared to post-study integrated care group
Patients over 60 years6 monthsNS
Pathways 113 SCL-20 6 monthsInterventionOR 3.5, 95% CI 2.16; 5.68
12 monthsInterventionOR 3.5, 95% CI 2.14; 5.72
Clarke, 2005 83 CES-D 12 months NSStudy may have been under-powered to compare 2 active treatments. About 75% remission in both groups within 3 months.
Hamilton Depression Rating Scale 12 months NS
Youth Self Report12 monthsNS
Katon, 2001 98 SCL-2012 monthsNS
Asarnow, 2005 114 CES-D 6 monthsIntervention-2.9, 95% CI -5.3; -0.4, p=.02
Percent with CES-D in severe range ≥246 monthsInterventionOR 0.6, 95% CI 0.4, 0.9, p=.02
High Level (Anxiety)
Price, 2000 91 Shedler Quick Psycho Diagnostics Panel (Anxiety)6 monthsInterventionP=.046
CCAP 9 Anxiety sensitivity index score 3 monthsInterventionEffect size 0.44
6 monthsInterventionEffect size 0.45
9 monthsInterventionEffect size 0.44
12 monthsInterventionEffect size 0.43
CES-D 3 monthsInterventionEffect size 0.29
6 monthsInterventionEffect size 0.29
9 monthsInterventionEffect size 0.27
12 monthsInterventionEffect size 0.26
Rollman, 2005 101 PDSS Panic disorder severity scaleAll patients12 monthsIntervention0.33, 95% CI; 04 to 0.62, p=.02Intervention × time
Panic disorder12 monthsIntervention0.57, 95% CI 0.18; 0.96, p=.003Intervention × time
*SIGH-A Hamilton anxiety rating scaleAll patients12 monthsIntervention0.38, 95% CI 0.09; 0.67, p=.03Intervention × time
General anxiety disorder12 months NS
Hamilton depression rating scaleAll patients12 monthsIntervention0.57, 95% CI 0.25; 0.46, p=.03Intervention × time
Intermediate Level (Depression)
Swindle, 2003 85 Beck depression inventoryAll patients3 months NSNo difference in outcomes for major depression or dysthymia. Several CNS were not voluntary, did not follow protocol, etc.
12 months NS
Major depression3 months NS
12 monthsNS
Simon, 2004 84 SCL-20Telephone psychotherapy plus care management6 monthsInterventionP<.001Difference between groups is equal to ½ of the SD of scores in general population
Telephone care management6 monthsInterventionNS
9 months post-treatmentNS
Boudreau, 2002 175 SCL-2012 monthsNS
PROSPECT 125 Hamilton Depression Rating ScaleAll patients4 months -3.5, 95% CI -4.7; -2.4, p<.001
8 months -2.1, 95% CI -3.4; -0.9, p<.001
12 months -1.8, 95% CI -3.1; -0.5, p=.006
Major depression4 months -4.6, 95% CI -6.2; -3.1, p<.001
8 months -2.5, 95% CI -4.1; -0.9, p.003
12 months -2.1, 95% CI -3.7; -0.4, p=.02
Clinically significant minor depression4 months NS
8 months NS
12 monthsNS
Tutty, 2000 89 SCL-20 3 monthsInterventionP=.03
6 monthsInterventionP=.03
RESPECT-D 120 SCL-20 3 monthsIntervention-0.16, 95% CI -0.32; -0.002, p=.048
6 monthsIntervention-0.20, CI -0.39 to -0.014, p=.036
Adler, 2004 106 Modified Beck depression inventory 3 months NS
6 monthsNS
Partners in Care 122, 123 Percent with probable depression based on CIDI screenQI-Meds6 monthsInterventionP<.05Time trends: Percent of usual care with probable depression dropped from 6 to 24 months while QI-Meds climbed. QI therapy remained relatively flat. QI meds significantly higher than QI therapy at 24 months.
12 monthsInterventionP<.05
18 months NS
24 months NS
Overall poor outcome: patient scored depressed if score in depressed range of all 3 CIDI screen, full 12-month CIDI, and CES-D, vs. 2 or fewer measures.QI-Meds6 months NS
12 months NS
18 months NS
24 monthsNS
QuEST 124 Modified CES-DPatients beginning new treatment episode6 monthsInterventionEffect size = 0.43
Patients recently treated6 months NS
Patients beginning new treatment episode, who find antidepressants acceptable6 monthsInterventionEffect size = 0.83This patient group also showed improvement in physical functioning, SF12 PCS, and satisfaction with care
Simon, 2000 99 SCL-20Care management arm6 monthsInterventionP=.008
Katzelnick, 2000 100 Hamilton depression score 3 monthsInterventionP=.04Significant group × time as well
6 monthsInterventionP<.001
12 monthsInterventionP=.005
Intermediate Level (Anxiety)
Roy-Byrne, 2001 109 PDSS Panic disorder severity scale 3 months NSIntervention × time p=.05, driven by reduction in anticipatory anxiety
6 monthsInterventionP=.003
9 months NS
12 months NS
Anxiety sensitivity scale 3 monthsInterventionP=.002Intervention × time p=.018
6 monthsInterventionP<.001
9 months NS
12 monthsInterventionP=.035
Panic related agoraphobic avoidance 12 months NS
Fear Questionnaire agoraphobic subscale 12 months NS
CES-D 3 monthsInterventionP=.002Intervention × time p=.03
6 monthsInterventionP=.005
9 monthsInterventionP=.036
12 monthsInterventionP=.02
Low Level (Depression)
Finley, 2003 108 Brief inventory for depressive symptoms6 monthsNS
Katon, 1999 3, 103 SCL-20All patients3 monthsInterventionP=.003
6 monthsInterventionP=.04Treatment × time
All patients28 monthsInterventionP=.05Treatment × time
Moderate severity28 monthsInterventionP=.004Treatment × time
High severity28 monthsNS
Lin, 1999 4 (followup of Katon, 1995 and Katon, 1996)SCL-20 19 months NS
Inventory for depressive symptomatology19 monthsNS
Partners in Care 122, 123 Percent with probable depression based on CIDI screenAll interventions6 monthsAny interventionP=.001
12 monthsAny interventionP=.005
QI-Therapy6 monthsInterventionP<.05
12 monthsInterventionP<.05
18 months NS
24 months NS
Overall poor outcome: patient scored depressed if score in depressed range of all 3 CIDI screen, full 12-month CIDI, and CES-D, vs. 2 or fewer measures.QI-Therapy6 monthsInterventionP<.05
12 monthsInterventionP<.05
18 monthsIntervention, usual care and QI-MedsP<.05
24 monthsIntervention, QI-MedsP<.05
Hunkeler, 2000 110 (reporting telehealth nurse only, not peer support)Hamilton depression rating score 6 weeks NS
6 monthsInterventionP=.006
Beck depression rating score 6 weeks NS
6 monthsNS
Low Level (Other Disorders)
Katon, 1992 107 SCL somatization 6 months NS
12 months NS
SCL depression 6 months NS
12 months NS
SCL anxiety 6 months NS
12 monthsNS
TREATMENT RESPONSE
High Level(Depression)
Hedrick, 2003 87 Percent with 50% improvement in SCL-20 3 months NS
9 monthsNS
IMPACT 2, 179 Percent with 50% improvement in SCL-20 3 monthsIntervention2.73, 95% CI 2.10; 3.54, p<.001
6 monthsIntervention2.21, 95% CI 1.76; 2.76, p<.001
12 monthsIntervention26.85, 95% CI 22.34; 31.35, p<.0001
18 monthsIntervention16.99, 95% CI 12.34; 21.64, p<.0001
24 monthsIntervention10.87, 95% CI 6.16; 15.57, p<.0001
Fortney, 2006 92 Percent with 50% improvement in SCL-20 6 monthsInterventionNNT=11
12 monthsInterventionNS
Pathways 113 Percent with 50% improvement in SCL-90 6 months NS
12 monthsNS
Grypma, 2006 93 Percent with 50% improvement in PHQ-9All depression patients6 months NSIMPACT intervention group compared to post-study integrated care group.
Patients over 60 years6 monthsNS
PROSPECT 125, 127 Percent with 50% improvement in HRSDAll patients4 months OR 2.7, 95% CI 1.5; 4.9, p=.001At 8 months, patients taking medication only showed more improvement than patients with IPT only, P=.02
8 months OR 2.1, 95% CI 1.1; 3.8, p=.02
12 months OR 2.0, 95% CI 1.1; 3.8P=.02
Major depression4 months OR 3.9, 95% CI 1.8; 8.5, p<.001
8 months OR 3.0, 95% CI 1.4; 6.4P=.006
12 months NS
Clinically significant minor depression4 months NS
8 months NS
12 monthsNS
Katon, 1996 88 Percent with 50% improvement in SCL-20Major depression4 monthsInterventionP=.002Group × time trend
7 monthsInterventionP=.04Group × time trend
Minor depression4 months NS
7 monthsNS
High Level (Anxiety)
Rollman, 2005 101 40% reduction in SIGH-AAll patients12 monthsIntervention30.8, 95% CI 17.0; 44.7, p<.001
General anxiety disorder12 months NS
40% reduction in PDSSAll patients12 monthsIntervention20.7, 95% CI 9.7; 31.5, p<.001
Panic disorder12 monthsIntervention32.2, 95% CI 15.5; 48.9, p<.001
40% reduction in Hamilton depression ratingAll patients12 monthsIntervention28.5, 95% CI 15; 42.6, p<.001
Intermediate Level (Depression)
Simon, 2004 84 Percent with 50% improvement in SCL-20Telephone care management6 monthsInterventionNSUsual care as comparison
Telephone psychotherapy plus care management6 monthsInterventionNNT=6.4Usual care as comparison
Tutty, 2000 89 Percent with 50% improvement in SCL-20 3 months NS
6 monthsNS
RESPECT-D 120 Percent with 50% improvement in SCL-20 3 monthsInterventionOR 2.2, 95% CI 1.4; 3.4, p=.001
6 monthsInterventionOR 1.7, 95% CI 1.1; 2.7, p=.021
Finley, 2003 108 Percent with 50% improvement in brief inventory for depressive symptoms6 monthsNS
Datto, 2003 97 Percent with 50% improvement in CES-D 16 weeks NS
Percent with 50% improvement in Beck depression rating score 6 weeks NS
6 monthsP=.05
Simon, 2000 99 Percent with 50% improvement in SCL-20Care management arm6 monthsInterventionOR 2.22, 95% CI 1.31; 3.75
Katzelnick, 2000 100 Percent with 50% improvement in Hamilton depression score12 monthsInterventionP<.00153.2% compared to 32.8%
Intermediate Level (Anxiety)
Roy-Byrne, 2001 109 40% reduction in PDSS 3 months NS
6 monthsInterventionP=.001
9 months NS
12 monthsInterventionP=.048
Low Level (Depression)
Hunkeler, 2000 110 (reporting telehealth nurse only, not peer support)Percent with 50% improvement in Hamilton depression rating score 6 weeksInterventionP=.01
6 monthsInterventionP=.003
REMISSION
High Level (Depression)
Katon, 1999 103 Percent with SCID ≤1 3 monthsInterventionP=.01
6 monthsInterventionP=.05
Hedrick, 2003 87 Percent with SCL-20 ≥1.753 monthsNSCollaborative care patients with baseline scores above 1.75 were significantly less likely to be above 1.75 at 3 months.
Fortney, 2006 92 Percent with SCL-20 <0.5 6 months NS
12 monthsInterventionNNT=11
IMPACT 2, 121 Percent with SCL-20 <0.5 3 monthsIntervention3.63, 95% CI 2.46; 5.38, p<.001
6 monthsIntervention2.16, 95% CI 1.69; 2.76, p<.001
12 monthsIntervention17.48, 95% CI 13.78; 21.18, p<.0001
18 monthsIntervention9.31, 95% CI 5.77; 12.85, p<.0001
24 monthsIntervention5.65, 95% CI 2.12; 9.17, p=.0018
Percent with SCID ≤16 monthsInterventionOR 0.50, 95% CI 0.40; 0.62, P<.001
PROSPECT 125, 127 Percent with HRSD <10All patients4 monthsInterventionOR 3.7, 95% CI 1.7; 7.7, p=<.001Treatment × time p<.01 for medication only, vs. IPT only
8 months NS
12 months NS
Major depression4 monthsInterventionOR 6.7, 95% CI 2.5; 17.9, p<.001
8 months NS
12 months NS
Clinically significant minor depression4 months NS
8 months NS
12 months NS
Percent with HRSD <7All patients4 monthsInterventionOR 2.0, 95% CI 1.0; 3.8, p=.04
8 monthsInterventionOR 2.1, 95% CI 1.1; 4.2, p=.02
12 months NS
Major depression4 monthsInterventionOR 3.6, 95% CI 1.4; 9.4, p=.007
8 monthsInterventionOR 3.2, 95% CI 1.3; 7.9, p=.01
12 months NS
Clinically significant minor depression4 months NS
8 months NS
12 monthsNS
High Level (Anxiety)
CCAP 9 Anxiety sensitivity score <20 3 monthsInterventionEffect size 0.40
6 monthsInterventionEffect size 0.48
9 monthsInterventionEffect size 0.47
12 monthsInterventionEffect size 0.51
High end-state functioning 3 monthsInterventionEffect size 0.23
6 monthsInterventionEffect size 0.29
9 monthsInterventionEffect size 0.32
12 monthsInterventionEffect size 0.34
Price, 2000 91 Shedler quick diagnostics panel <10 (anxiety)6 monthsInterventionP=.02555.6% intervention vs. 22.8% control achieved remission
Intermediate Level (Depression)
Boudreau, 2002 175 Percent with major depression as measured with SCID12 monthsNS
Tutty, 2000 89 Percent with SCID ≤1 3 months NS
6 monthsNS
Partners in Care 122, 123 Percent with modified CES-D <20 6 monthsAll interventionsP=.005
12 monthsAll interventionsP=.04
Percent without clinical diagnosis, based on full 12-month CIDI2 yearsQI-therapy vs. QI-medsP=.04
RESPECT-D 120 Percent with SCL-20 <0.5 3 monthsInterventionOR 2.1, 95% CI 1.2; 3.7, p=.018
6 monthsInterventionOR 1.9, 95% CI 1.2; 3.3, p=.014
Datto, 2003 97 Percent below CES-D=16 (low level symptoms) 16 weeksInterventionOR 6.58, CI 1.57 to 27.03, p=.01
Percent below CES-D=11 16 weeks NS
9 monthsNS
QuEST 5 Percent below CES-D=1624 monthsInterventionP<.02Treatment × time
Katzelnick, 2000 100 Percent below Hamilton depression score<712 monthsInterventionP<.00127.7% compared to 12.8%
Intermediate Level (Anxiety)
Roy-Byrne, 2001 109 Anxiety sensitivity score <20 3 monthsInterventionP=.004
6 monthsInterventionP=.004
9 months NS
12 monthsInterventionP=.005
Low Level (Depression)
Finley, 2003 108 Percent with brief inventory for depressive symptoms <96 monthsNS
MEDICAL
High Level (Depression)
IMPACT 128, 129 Arthritis pain intensity 3 monthsIntervention-0.58, 95% CI -0.9; -0.25, p<.001
6 months NS
12 monthsIntervention-0.53, 95% CI-0.92; -0.14, p=.009
Arthritis interferes with daily activities 3 monthsIntervention-0.67, 95% CI -1.06; -0.27, p=.001
6 monthsIntervention-0.56, 95% CI -0.96; -0.16, p=.006
12 monthsIntervention-0.59, 95% CI -1; -0.19, p=.004
Arthritis pain interferes with daily activities 3 monthsIntervention-0.24, 95% CI -0.39; -0.09, p=.002
6 monthsIntervention-0.22, 95% CI -0.36; -0.09, p=.005
12 monthsIntervention-0.26, 95% CI -0.41; -0.10, p=.002
Graded chronic pain scale for arthritis pain severity 12 monthsInterventionBeta 0.15 (SE 0.06), p=.026Interaction: intervention × pain severity
12 months NSInteraction: intervention × pain activity interference
Graded chronic pain scale for arthritis pain activity interference 12 monthsInterventionBeta 0.14 (SE 0.07), p=.04Interaction: intervention × pain severity
12 monthsInterventionBeta 0.13 (SE 35), p=.015Interaction: intervention × pain activity interference
Pathways 113 HbA1c level6 monthsNS
12 monthsNS

From: 3, Results

Cover of Integration of Mental Health/Substance Abuse and Primary Care
Integration of Mental Health/Substance Abuse and Primary Care.
Evidence Reports/Technology Assessments, No. 173.
Butler M, Kane RL, McAlpine D, et al.

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