Table 12Process or program outcomes and utilization

Outcome
Project or Author
MeasurementPatient CategoryAssessment PeriodDirection of EffectResultsComment
DEPRESSION
Adherence/Adequate Dosage
Fortney, 2006 92 Full dosage ≥80% of days 6 monthsInterventionNNT=8
12 monthsInterventionNNT=6
Fortney, 2006 131 Proportion of patients with active prescription, EMR source 6 months NS
12 monthsNS
Pathways 113 Any antidepressant refills 3 monthsInterventionOR 3.20, 95% CI 1.84; 5.58
6 monthsInterventionOR 2.29, 95% CI 1.38; 3.82
9 monthsInterventionOR 2.78, 95% CI 1.62; 4.76
12 monthsInterventionOR 2.18, 95% CI 1.32; 3.62
Pharmacy records, based on guidelines 1–6 monthsInterventionOR 4.15, 95% CI 2.28; 7.55
7–12 monthsInterventionOR 2.9, 95% CI 1.69; 4.98
Adler, 2004 106 Rate of antidepressant use, self-report 3 monthsInterventionP=.024High of 60.6% of patients using antidepressants at 3 months. Impact greatest for those not on antidepressants at baseline
6 monthsInterventionP=.025
Finley, 2003 108 HEDIS antidepressant adherence rate 3 months NS
6 monthsInterventionP=.03867% of patients using antidepressants in continuation phase.
Partners in Care 183 Any antidepressant use in past 6 months 6 monthsPIC-MedsP=.001Compared to usual care. Also significantly greater than PIC-Therapy at 6, 12, and 24 months.
12 monthsPIC-MedsP=.003
18 months NS
24 monthsNS
Datto, 2003 97 Treatment adherence, medication and psychotherapy if receiving care at baseline16 weeksNSAdherence was not predicted by age, gender, baseline physical and mental health status, or depression severity
Katon, 1999 3, 103 Adhere ≥90 days of adequate dosageAll patients1–6 monthsInterventionP<.00173% of intervention
7–12 months NS
11–28 months NS
Moderate severity1–6 monthsInterventionP<.0576% of intervention
7–12 months NS
11–28 months NS
High severity1–6 monthsInterventionP<.0172% of intervention
7–12 monthsInterventionP<.0570% of intervention
11–28 months NS
Adequate low-dose for 90 days, AHRQ guideline 6 monthsInterventionP<.0001
Adequate moderate-dose for 90 days, psychiatrist practice 6 monthsInterventionP=.002
Katon, 1995 102 Adhere ≥30 days of adequate dosageMinor depression1–7 monthsInterventionP<.001
Major depression1–7 monthsInterventionP<.001
Adhere ≥90 days of adequate dosageMinor depression1–7 monthsInterventionP<.001
Major depression1–7 monthsInterventionP<.01
Katon, 1996 88 Adhere ≥30 of adequate dosageMajor depression7 months NSPharmacy records
Adhere ≥30 of adequate dosageMinor depression7 monthsInterventionP<.002
Katon, 2001 98 Any antidepressant refill 12 monthsIntervention0.90, 95% CI 1.37; 2.65, p<.001
Adequate dosage12 monthsInterventionOR 2.08, 95% CI 1.41; 3.06
Boudreau, 2002 175 Use of antidepressants for at least 25 of past 30 days12 monthsNS
Simon, 2004 84 Adequate pharmacotherapy for 90 daysTelephone psychotherapy plus care management6 months NS
Telephone care management6 monthsInterventionP=.0154% received adequate dosage
Tutty, 2000 89 Adequate low-dose for 90 days, AHRQ guideline 3 months NS
6 months NS
Adequate moderate-dose for 90 days, psychiatrist practice 3 months NS
6 monthsNS
Lin, 1999, followup of Katon, 1995 and 1996 4 Adequate pharmacotherapy19 monthsNS
Simon, 2000 99 Adequate low-dose for 90 days, AHRQ guidelineCare management arm6 months NS
Adequate moderate-dose for 90 days, psychiatrist practiceCare management arm6 monthsInterventionOR 1.99, 95% CI 1.23; 3.22
Process of Care/Program Use
Grypma, 2006 93 Care manager contacts UnclearPost-study19.8 to 13.6 contacts, p<.001Post-study group used less care manager services than IMPACT RCT.
Use of any PST-PC Unclear NS
Use of antidepressantUnclearNS
IMPACT 2, 121 Percent self-reported use of antidepressant 3 monthsInterventionOR 2.02, 95% CI 1.66; 2.44, p<.00112 months showed highest percent using antidepressants in intervention (73%)
6 monthsInterventionOR 2.02, 95% CI 1.66; 2.47, p<.001
12 monthsIntervention18.46, 95% CI 13.53; 23.40), p<.0001
18 monthsIntervention14.74 95% CI 9.58; 19.89, p<.0001
24 monthsIntervention13.91, 95% CI 8.69; 19.14, p<.0001
Percent self-reported use of any specialty mental health visits or psychotherapy 3 monthsInterventionOR 3.77, 95% CI 3.02; -4.70, p<.00112 months showed highest percent using mental health in intervention (43%)
6 monthsInterventionOR 4.47 95% CI 3.47; 5.77. p<.001
12 monthsIntervention28.18, 95% CI 23.79; 32.57), p<.0001
18 months NS
24 months NS
Percent self-reported use of any depression treatment 3 monthsInterventionOR 3.33, 95% CI 2.68; 4.13, p<.00112 months showed highest percent using any treatment in intervention (82%)
6 monthsInterventionOR 2.93, 95% CI 2.34; 3.67, p<.001
12 monthsIntervention25.69, 95% CI 21.03; 30.35, p<.0001
18 monthsIntervention15.19, 95% CI 10.07; 20.31, p<.0001
24 monthsIntervention13.78, 95% CI 8.55; 19.00, p<.0001
Pathways 113 4 or more specialty mental health visits12 monthsIntervention29.31, 95% CI 14.65; 58.6667.7% of intervention patients reported 4 or more visits
PROSPECT 125 Medication and psychotherapy 4 months NS
8 months NS
12 monthsIncreased for controlOR 0.25, 95% CI 0.07; 0.96, p<.001
Medication only 4 monthsIncreased for interventionOR 4.91, 95% CI 2.13; 11.33, p<.001
8 monthsIncreased for interventionOR 4.20, 95% CI 1.77; 9.96, p<.001
12 monthsIncreased for interventionOR 7.21, 95% CI 2.86; 18.18, p<.001
Psychotherapy only 4 monthsIncreased for interventionOR 43.93, 95% CI 11.59; 166.42, p<.001
8 monthsIncreased for interventionOR 163.48, 95% CI 21.90; 1220.57, p<.001
12 monthsIncreased for interventionOR 41.15, 95% CI 6.22; 272.39, p<.001
No treatment 4 monthsIncreased for controlOR 0.003, 95% CI 0; 0.02, p<.001
8 monthsIncreased for controlOR 0.004, 95% CI 0; 0.02, p<.001
12 monthsIncreased for controlOR 0.02, 95% CI 0; 0.07, p<.001
RESPECT-D 120 Percent taking antidepressants 3 months NS
6 months NS
Percent received counseling in past 3 months 3 months NS
6 monthsNS
Simon, 2004 84 Primary care visits for mental health diagnosisTelephone psychotherapy plus care management6 monthsIncreased for interventionP=.01
Telephone care management6 monthsIncreased for interventionP=.01
Primary care visits for other than mental healthTelephone psychotherapy plus care management6 monthsDecreased for interventionP=.02
Telephone care management6 months NS
Mental health specialty visits for medication managementTelephone psychotherapy plus care management6 months NS
Telephone care management6 months NS
Mental health specialty visits for psychotherapyTelephone psychotherapy plus care management6 monthsDecrease for interventionP=.02
Telephone care management6 months NS
Total primary care and mental health visitsTelephone psychotherapy plus care management6 months NS
Telephone care management6 months NS
≥4 psychotherapy sessionsTelephone psychotherapy plus care management6 monthsIncrease for interventionP<.001
Telephone care management6 monthsIncrease for interventionP=.01
Partners in Care 123, 136 Percent with overall appropriate careAll interventions6 monthsInterventionP<.001
QI-meds6 monthsInterventionP<.001
QI-therapy6 monthsInterventionP=.002
All interventions12 monthsInterventionP=.006
QI-meds12 monthsInterventionP<.001QI meds also higher than QI therapy, P=.02
QI-therapy12 months NS
Percent with appropriate antidepressant medicationAll interventions6 monthsInterventionP=.001
QI-meds6 monthsInterventionP=.001
QI-therapy6 months NS
All interventions, if appropriate at baseline6 months NS
All interventions, if not appropriate at baseline6 monthsInterventionP<.001
All interventions12 monthsInterventionP=.01
QI-meds12 monthsInterventionP<.001
QI-therapy12 months NR
All interventions, if appropriate at baseline12 monthsInterventionP=.006
All interventions, if not appropriate at baseline12 months NS
Percent with any specialty counselingAll interventions6 monthsInterventionP<.001
QI-meds6 monthsInterventionP=.003
QI-therapy6 monthsInterventionP<.001
All interventions, if counseled prior to baseline6 months NS
All interventions in not counseled prior to baseline6 monthsInterventionP<.001
All interventions12 monthsInterventionP=.03
QI-meds12 monthsInterventionP=.003
QI-therapy12 months NR
All interventions, if counseled prior to baseline12 months NS
All interventions in not counseled prior to baseline12 monthsInterventionP=.05
Measures of use of psychotherapyQI-med, QI-therapy, usual care2 yearsQI-therapy showed significantly higher use of high and low doses of psychotherapy, CBT-type therapy, number of session. Major depression was driver of different use patterns.
Measures of use of medicationQI-med, QI-therapy, usual care2 yearsQI-med had significantly higher rates of antidepressant use and reduction in long-term minor tranquilizer use compared to QI-therapy or usual care.
Hedrick, 2003 87 Percent receiving antidepressants9 monthsInterventionP<.000180% intervention patients received antidepressants
Katon, 1999 103 Mean PCP visits 12 weeks NS
6 months NS
Percent with at least one non-study mental health visit 12 weeks NS
6 months NS
Mean non-study mental health visits 12 weeks NS
6 monthsNS
QuEST 5 Use of antidepressants 24 monthsInterventionP<.0001Intervention group used 6.5 months vs. 3.4 months for control group
Use of mental health counseling 6 monthsInterventionP<.0001
12 months P=.01
18 months NS
24 monthsNS
Asarnow, 2005 114 Any specialty mental health care 6 monthsInterventionOR 2.8, 95% 1.6, 4.9, p<.001
Any psychotherapy or counseling 6 monthsInterventionOR 2.2, 95% 1.3, 3.9, p=.007
Number of counseling visits 6 monthsInterventionOR 2.4, 94% CI 1.4, 4.1, p=.003
Any medication 6 months NS
Any mental health treatment by primary care clinical6 monthsNS
Satisfaction with Treatment
Fortney, 2006 131 Total behavioral health satisfaction, Experience of Care and Health Outcomes Survey 6 monthsInterventionNNT=8
12 monthsInterventionNNT=9
PRISM-E 184 Client satisfaction questionnaire12 monthsIntegrated careMean score 3.4 vs. 3.2, p<.001Driven by referral care indicating lower level of “services received met your needs.” Those with lower SES and higher perceived stigma were less likely to be satisfied.
IMPACT 2, 121 Satisfaction with depression care 3 monthsInterventionOR 3.26, 95% CI 2.52; 4.22, p<.001
12 monthsIntervention27.95, 95% CI 22.45; 33.45, p<.0001
18 monthsIntervention14.11, 95% CI 7.91; 20.30, p<.0001
24 monthsIntervention12.96, 95% CI 6.48; 19.44, p=.0001
Clarke, 2005 83 Satisfaction with care12 monthsNS
Pathways 113 Satisfaction with treatment 6 monthsInterventionOR 2.01, 95% CI 0.57; 1.40
12 monthsInterventionOR 2.88, 95% CI 1.67; 4.97
RESPECT-D 120 Rating of care as good to excellent 3 monthsInterventionP=.008
6 monthsInterventionP=.0003
Simon, 2004 84 “Very satisfied” with treatmentTelephone psychotherapy plus care management6 monthsInterventionP<.001
Telephone care management6 monthsInterventionP=.001
Finley, 2003 108 Overall satisfaction with treatment6 monthsInterventionP=.023Significant for 7 of 11 satisfaction items
Swindle, 2003 85 Overall satisfaction 3 months NS
12 monthsNS
Katon, 1999 103 Satisfaction with treatment3 monthsInterventionP<.00001
Katon, 1995 102 Satisfaction with treatmentMinor depression4 months NS
Major depression4 monthsInterventionP<.03
Satisfaction with medicationMinor depression4 monthsInterventionP<.02
Major depression4 monthsInterventionP<.01
Katon, 1996 88 Satisfaction with treatmentMajor depression4 monthsInterventionP<.009
Minor depression4 monthsInterventionP=.003
Hedrick, 2003 87 Overall satisfaction with treatment9 monthsNS
Boudreau, 2002 175 Satisfaction with depression care12 monthsNS
Hunkeler, 2000 110 (reporting telehealth nurse only, not peer support)Satisfaction with treatment 6 weeksInterventionP=.004
6 monthsInterventionP=.001
Asarnow, 2005 114 Satisfaction with mental health care6 monthsIntervention0.3, 95% CI 0.1, 0.5, p=.004
Guideline concordance
Datto, 2003 97 Clinician adherence with guidelinesAll patients12 weeks NS
Patients who required treatment adjustment12 weeksOR 7.03, 95% CI 1.03; 48.01, p=.05
ANXIETY DISORDERS
Adherence/Adequate Dosage
Roy-Byrne, 2001 109 Adherent more than 25 days 3 monthsInterventionP<.05
6 monthsInterventionP<.05
9 months NS
12 monthsNS
Roy-Byrne, 2001 109 % received appropriate type of medication 3 monthsInterventionP<.05
6 months NS
9 months NS
12 months NS
% received adequate dosage and duration 3 monthsInterventionP<.05
6 monthsInterventionP<.05
9 months NS
12 monthsNS
CCAP 9 % received appropriate anti-panic medicationAll months (through 12 months)NS
Process of Care/Program Use
CCAP 9 % received ≥3 counseling sessions plus at least 4 of 7 CBT techniques 3 monthsInterventionP<.001Highest proportion was 63% of intervention group at 3 months
6 monthsInterventionP=.005
9 months NS
12 monthsInterventionP=.02
% received any anti-panic medication 3 months NS
6 months NS
9 months NS
12 months NS
% received any counseling 3 monthsInterventionP<.001Highest proportion was 70% of intervention group at 3 months
6 monthsInterventionP=.05
9 monthsInterventionP=.004
12 monthsInterventionP<.001
Rollman, 2005 101 % on medication 12 monthsIntervention23.9, 95% CI 7.1; 41.8, p=.006NS at 4, 8, and 12 months
% with mental health specialty visit12 monthsNS18% in intervention vs. 26% in control
Satisfaction with Treatment
Roy-Byrne, 2001 109 Satisfaction with treatment12 monthsInterventionP=.039
Price, 2000 91 Satisfaction with anxiety treatment6 monthsInterventionP<.000110 of 11 satisfaction items significant
OTHER DISORDERS
Titration Trials
Epstein, 2007 112 Improvement in % physicians using titration trials12 monthsInterventionBeta -.283, SE 0.09, p<.01Collaborative care physicians increased from 9% to 68%, compared to no increase in control group
Medication Management
Epstein, 2007 112 Improvement in % physicians systematic monitoring medication12 monthsNSBoth groups increased. 36% of collaborative care group did not monitor

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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