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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  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

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Integration of Mental Health/Substance Abuse and Primary Care.

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Appendix D: Patient Inclusion and Exclusion Criteria

Project Name or Author, Year, Study DesignInclusion CriteriaExclusion Criteria
Depression Disorders
Fortney, 2007 1, 2 Current VA patients diagnosed with depression. 92% male, 75% white, mean age 59, Control N=218; Intervention N=177Schizophrenia, current suicide ideation, recent bereavement, pregnancy, a court-appointed guardian, substance dependence, bipolar disorder, cognitive impairment, or receiving specialty mental health treatment.
PRISM-E (for depression) 3 5 Elderly primary care patients. 31% female, 55% non-white, mean age 74, Integrated N=758; Referral N=773Already received mental health/substance abuse treatment in the preceding 3 months and patients with severe cognitive impairment (≥16 on the Brief Orientation Memory Concentration Test), positive assessment on the Mini-International neuropsychiatric Interview for psychosis, mania, or hypomania
Geron, 2006 6 Current patients over 65 years with 2 or more chronic medical conditions, ER visit or hospital admission in past 6 monthsN/A
Grypma, 2006 7 Current adult patients. 8.4% male, average age 63, 63% above 60 years, RCT controls N=116, Post-study intervention N=95N/A
IMPACT 8 12 Current patients 60+ years old with depression. 65% female, 77% white, Control N=895, Intervention N=906Drinking problems, bipolar disorder or psychosis, severe cognitive impairment, acute risk of suicide, or ongoing psychiatric treatment
Clarke, 2005 13 Pediatric patients ages 12–18 years old in a current major depression episode. Average age 15, 77% female, 14% non-white. Control N=75, Intervention N=77Schizophrenia or significant developmental/intellectual disability
PROSPECT 14 16 English speaking patients over 60 years with major depression. 31% above age 75, 72% female, 32% non-white.Suicidal ideation, not English speaking, score ≤17 on the Mini-Mental State Examination
Pathways 17, 18 English speaking adult diabetes patients with major depression. Average age 58, 65% female, 81% white.Currently in care with a psychiatrist; a diagnosis based on GHC's automated diagnostic data of bipolar disorder or schizophrenia; use of antipsychotic or mood stabilizer medication based on GHC's automated pharmacy data; and mental confusion on interview or significant dementia; SCL<1.1.
RESPECT-D 19, 20 English speaking patients 18 years or older starting treatment for major depression. Average age 42, 80% female, 17% non-white.Unobtainable for an evaluation interview within 14 days of their index primary care visit, pregnant, suicidal thoughts, schizophrenia, bipolar disorder, post-traumatic stress disorder, substance misuse disorder
Simon, 2004 21 Adult patients beginning antidepressant treatment. Average age 44, 74% female, 79% whiteCurrent alcoholism, bipolar disorder, and/or psychotic disorders.
Adler, 2004 22, 23 English speaking adults with major depression. Average age 42, 72% female, 72% white.Current alcoholism, bipolar disorder, and/or psychotic disorders. (Lifetime alcoholism or psychiatric conditions not excluded)
Finley, 2004 24 Adult patients beginning antidepressant treatment. Average age 54, 85% female.Antidepressant use during the preceding 6 months; concurrent psychiatric or psychologic treatment; mania or bipolar disorder; psychotic symptoms; eminent suicidality; active substance abuse or dependence
Swindle, 2003 25 Community dwelling adult patients with depression dysthymia, or partially remitted major depression using PRIME-MD structured diagnostic interview. 97% male, 85% white. Control N=134, Treatment N=134Incompetent for interview: active psychosis, dementia documented in medical chart; residents of a nursing home; actively suicidal; seen in a VAMC mental health program; active cocaine or opiate abusers; bipolar disorder; terminally ill.
Partners in Care 26 30 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=464Pregnant; mania or recent alcohol abuse; not insured by a plan or public-pay arrangement; <18 years; did not speak English or Spanish
Datto, 2003 31 Patients with depression. Average age 48, 61% female, 80% white. Control N=31, Intervention N=30Suicidal risks, ongoing substance abuse problems, current psychotic symptoms, bipolar affective disorder
Hedrick, 2003 32 Current patient with major depression, dysthymia, or both. Average age 57, 95% male, 80% white. Control N=186, Intervention N=168Recent visit to a mental health specialty clinic or scheduled a future appointment, required treatment for substance abuse or posttraumatic stress disorder prior to initiating depression treatment; acute suicidality, psychosis, or other condition requiring immediate treatment
Katon, 1995 33 English speaking, current adult patients beginning antidepressants. Average age 48, 76% female. Control N=109, Intervention N=108Current alcohol abuse; current psychotic symptoms or serious suicidal ideation or plan; dementia; pregnancy; terminal illness; limited command of English; plan to disenroll from the GHC insurance plan within the next 12 months
Katon, 1999 34 English speaking, current adult patients beginning antidepressants. Average age 47, 75% female, 80% white. Control N=114, Intervention N=114Screening score >2 on the CAGE alcohol screening questionnaire; pregnant or currently nursing; planning to disenroll from the GHC insurance plan in the next 12 months; currently seeing a psychiatrist; non English speaking; recently using lithium or antipsychotic medication
Katon, 1996 35 English speaking, adult age 18 to 80 years old, beginning antidepressants. Average age 46, 74% female, 87% whiteCurrent alcohol abuse; current psychotic symptoms or serious suicidal ideation or plan; dementia; pregnancy; terminal illness; limited command of English; plan to withdraw from GHC insurance plan within the next 12 months
Katon, 2001 36, 37 English speaking, current adult patients beginning antidepressants. Patients at high risk of relapse, recovered from depression 6 to 8 weeks after initiation of pharmacotherapy by their PCP. Average age 46, 73% female, 90% white. Control N=192, Intervention N=194N/A
Capoccia 2004 38, 39 English speaking current adult patients beginning antidepressants. Average age 39, 57% female, 22% non-white. Control N=33, Intervention N=41Age <18 years; terminal medical illness; cognitive impairment; psychosis; current alcohol or substance abuse; suicide attempts or current suicide plan; pregnant or nursing; limited command of English; not intending to use the FMC as a source of care for the next 12 months
Tutty, 2000 40 Adult patients beginning antidepressants. Average age 47, 69% female. Control N=94, Intervention N=28Bipolar disorder, schizophrenia, or schizoaffective disorder during past 2 years; active alcohol or other substance abuse during the previous 90 days; or visit to a psychiatrist within the previous 90 days.
Hunkeler 2000 41 English speaking adults with SSRI prescription for depression. About 70% female, 37% non-white. Control N=123 Intervention N=179Previous antidepressant drug prescription within the past 6 months; inadequate command of the English language; reported current problems with substance abuse; current suicide risk; reported thoughts of violence.
QuEST 39, 42, 43 English reading current adult patients with depression. Average age 43, 84% female, 16% non-white. Control N=240, Intervention N=239Bereavement, mania, alcohol dependence, pregnancy or the postpartum period, life threatening physical illness; no intent to use the clinic as their usual source of care during the year after the index visit; no telephone access; patients who were illiterate in English cognitively impaired.
Simon, 2000 44 Current adult patients newly prescribed antidepressants. Average age 46 years, 72% female. Control N=196Nondepression indication for prescription; bipolar disorder or psychotic disorder in the previous two years; alcohol or other substance misuse in the previous 90 days; or had visited a psychiatrist in the previous 90 days.
Hilty, 2007 45 English speaking current adult patients with depression willing to take antidepressantsWithout a primary diagnosis of major depression; suicidal intention or plans; dementia, pregnancy, terminal illness, and plans to move in the next 12 months; all other psychiatric and medical disorders.
Katzelnick, 2000 46 Current adult patients above 85th percentile in utilization for previous 2 yearsRecent treatment for alcohol or other substance abuse; past treatment for schizophrenia or bipolar disorder; life-threatening medical disorders; active treatment for depression.
Anxiety Disorders
Roy-Byrne 2001 47 English speaking adult patients with at least 1 panic attack in last month. Average age 41, 57% female, 67% whiteCurrently receiving psychiatric treatment and receiving or applying for disability benefits
CCAP 48, 49 English speaking adult patients between 18 and 70 years of age with at least 1 panic attack within last week. Average age 41, 67% female, 66% white, Control N=113, Intervention N=119Suicidal ideation, terminal medical illness, psychosis, current substance abuse, dementia, pregnancy; already on psychiatrist or CBT.
CALM 50 English speaking adult current patients with GAD, PTSD, PD and SADSerious alcohol or drug use; unstable medical conditions, marked cognitive impairment, active suicidal intent/plan, psychosis or bipolar I disorder; ongoing medication management or CBT; without routine access to a telephone or who could not speak English or Spanish
Rollman, 2005 51, 52 English speaking, adult current patients with anxiety disorders. Average age 44 years, 81% female, 95% white. Control N=75, Intervention N=116Receiving treatment from a mental health professional; bipolar disorder; leave the study practice within the following year.
Price, 2000 53 English speaking, adult current patients with GAD. Mean age 49 years, 80% female, 86% white. Control N=111, Intervention N=113Current alcohol and substance abuse, planned to disenroll from Kaiser Permanente within 12 months from entrance into the study, had difficulty speaking English; psychosis or dementia; terminal illness
Somatizing Disorders
Katon, 1992 54 Top 10% adult ambulatory care utilizes of appropriate age group with psychiatric distress, SCL >13. Average age 47, 61% femalePregnant; not known to the physician; dementia or psychotic illness; terminally ill or too ill to participate; changing physicians; terminating GHC enrollment within the next year
Escobar, 2007 55 Adults with undiagnosed somatic symptoms. 88% female, 68% Hispanic. Mean age 40. Control N=85, Intervention N=87insufficient somatization; scheduling difficulties; psychiatric exclusions; concurrent treatment; medical exclusions; concurrent legal issues.
Other
Epstein, 2007 56 1st through 5th grade children with ADHDNot reported
PRISM-E (for at-risk alcohol use) 4, 5, 57 Elderly primary care patients. 92% male, 70% white, mean age 72, Intervention N=280, Referral N=280Psychosis, mania, hypomania, severe cognitive impairment
Backward Integration
Weisner, 2001 58 Adult patients admitted to a chemical dependency program. Mean age 37, 55% male, 74% white. Control N=307, Intervention N=285N/A
Druss, 2001 59 VA mental health patients without a current primary care provider. Mean age 45, 99% male, 70% white, Control N=61, Intervention N=59With current PCP or an urgent or multiple serious chronic problems
Willenbring, 1999 60 VA patients with current alcohol abuse behavior and alcohol-related medical illness. Mean age 55.1, Control N=53, Intervention N=48Terminal illness with a life expectancy of less than 12 months from a nonalcohol-related illness; severe dementia; major psychiatric disorder other than depression; current polysubstance abuse or drug of choice other than alcohol; civil commitment to treatment or a pending commitment action.

References for Appendix D

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