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  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Appendix E: Evidence Table

Project Name or 1st Author, Year, Study DesignStudy AimStudy PeriodPatient PopulationSettingsOutcomes Measured
Depression Disorders
Fortney, 2007 1, 2
RCT
Randomized by matched site
Assess telemedicine - based collaborative care vs. usual care to improve depression care at small clinics without on-site psychiatrists.Recruitment 2003. Study period 12 months.Current VA patients diagnosed with depression. 92% male, 75% white, mean age 59.
Control N=218
Intervention N=177
7 rural VA community-based outpatient clinics with no on-site psychiatry or psychology in AK, MS, LA.Depression symptoms, remission, treatment response, adherence. Physical, mental quality of life, wellbeing, and patient satisfaction. Model fidelity.
PRISM-E (for depression) 3 5
RCT
Randomized by patient
Assess integrated vs. enhanced referral care for improving depression outcomes in elderly patients.Recruitment March 2000 to March 2002. Study period 6 monthsElderly primary care patients: 31% female, 55% non-white, mean age 74
Integrated N=758
Referral N=773
10 practices with 34 urban, suburban, and rural clinics. 5 VA, 3 community health, 2 hospital networks in the Northeast, Miami, and ChicagoDepression symptoms, remission, MH QoL. Program use.
Geron, 2006 6
RCT
Assess social worker care manager vs. usual care for depressed home-dwelling frail elderlyStudy period 12 months. Recruitment period not completed.Current patients over 65 years with 2 or more chronic medical conditions, ER visit or hospital admission in past 6 monthsAn MCO urban primary care clinic.Depression symptoms, satisfaction, QoL, adverse health outcomes, physical function, utilization, cost
Grypma, 2006 7
Cohort
Assess adapted version of IMPACT post trial vs. usual care on depression care for adults.Study period 12 months. IMPACT study period 1999-2001. Post-trial data from 2002-2004.Current adult patients. 8.4% male, average age 63, 63% above 60 years
RCT controls N=116
Post-study intervention N=95
2 Kaiser Permanente practices in San Diego areaDepression symptoms, utilization
IMPACT 8 12
RCT
Randomized by patient
Assess collaborative care vs. usual care on depression care for elderly.Recruitment July 1999 to August 2000. Intervention 12 months. Study period 2 years.Current patients 60+ years old with depression. 65% female, 77% white,
Control N=895
Intervention N=906
7 national sites in Indiana, Texas, Washington, and California. Rural and urban. Group and academic practices, and VA.Depression symptoms, treatment response, remission, patient self-efficacy, function and QoL, satisfaction, antidepression medication use, treatment utilization
Clarke, 2005 13
RCT
Randomized by patient
Assess collaborative care with CBT vs. usual care for depressed HMO pediatric primary care patients.Recruitment March 2000 to November 2001. Study period 1 year.Pediatric patients age 12–18 years old in a current major depression episode. Average age 15, 77% female, 14% non-white.
Control N=75
Intervention N=77
HMO pediatric clinic in Portland, OR, part of Kaiser PermanenteDepression symptoms, relapse, QoL, satisfaction, utilization
PROSPECT 14 16
RCT
Randomization by matched sites
Assess guideline based depression recognition and treatment program vs. usual care for elderly patients to prevent and reduce suicidal behaviorRecruitment May 1999 to August 2001. Study period 2 yearsEnglish speaking patients over 60 years with major depression. 31% above age 75, 72% female, 32% non-white.
Control N=278
Intervention N=320
18 clinics in New York, Pennsylvania, and Pittsburgh. Group, university affiliated, and solo practices in urban, suburban, and rural locations.Depression symptoms, treatment response, and remission, utilization
Pathways 17, 18
RCT
Randomized by patient
Assess collaborative care vs. usual care for adult diabetes patients with depressionRecruitment April 2001 to May 2002. Intervention 12 months. Study period 2 yearsEnglish speaking adult diabetes patients with major depression. Average age 58, 65% female, 81% white.
Control N=165
Intervention N-165
9 HMO clinics within 40 mile radius of Seattle.Depression symptoms, diabetes outcomes and self-care, functional and QoL, adherence and utilization, cost-effectiveness.
RESPECT-D 19, 20
RCT
Assess evidence-based model of depression management vs. usual care for adult patients with depressionRecruitment February 2002 to February 2003. Patient study period 6 months.English speaking patients 18 years or older starting treatment for major depression. Average age 42, 80% female, 17% non-white.
Control N=181
Intervention N=224
3 medical groups and 2 health plans across U.S., each with at least 10 PC practices and established QI programs. 60 practices, matched and randomized.Depression symptoms, treatment response, remission, utilization
Simon, 2004 21
RCT
Randomized by patient
Assess telephone care management and telephone care management plus psychotherapy vs. usual care for adult patients with depression.Recruitment November 2000 to May 2002. Study period 6 months.Adult patients beginning antidepressant treatment. Average age 44, 74% female, 79% white
Control N=195
Telephone care N=207
Telephone care + psychotherapy N=198
7 urban and suburban HMO clinics in Washington State.Depression symptoms, remission, adequate pharmacotherapy.
Adler, 2004 22, 23
RCT
Randomized by patient
Assess pharmacist adherence management vs. usual care for adult patients with depression.Study period 6 months. Recruitment not reported.English speaking adults with major depression. Average age 42, 72% female, 72% white.
Control N=265
Intervention N=268
9 group practice clinics in Boston area, with 5 clinics at an academic medical center.Depression symptoms, antidepressant utilization and adherence.
Finley, 2004 24
RCT
Randomized by patient
Assess collaborative care with pharmacist care manager vs. usual care for adults with depression.Study period 6 months. Recruitment not reportedAdult patients beginning antidepressant treatment. Average age 54, 85% female.
Control N=50
Intervention N=75
HMO clinic in San Rafael, CA.Depression symptoms, treatment response, remission, change in disability, adherence and utilization, cost.
Swindle, 2003 25
RCT
Randomized by patient
Assess collaborative care with MH clinical nurse care manager vs. usual care for veterans with depressionStudy period 12 months. Recruitment not reported.Community dwelling adult patients with depression. 97% male, 85% white.
Control N=134
Treatment N=134
2 Indianapolis VA clinics, randomized by site.Depression symptoms, utilization, cost.
Partners in Care 26 30
RCT
Randomized by site
Assess quality improvements in medication management and therapy vs. usual care for adults with depressionIntervention 6 months. Study period 2 years. Recruitment not reported.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=464
6 MCOs representing geographically diverse regions in U.S., with 46 clinics.Depression symptoms, QoL, employment, utilization, overall poor outcome (constructed measure)
Datto, 2003 31
RCT
Randomized across sites
Assess telephone-based depression management for acute phase depression vs. usual care for adult patients.Study period 16 weeks. Recruitment not reported.Patients with depression. Average age 48, 61% female, 80% white.
Control N=31
Intervention N=30
35 urban and suburban clinics in Pennsylvania.Depression symptoms, QoL, clinician and patient adherence.
Hedrick, 2003 32
RCT
Randomized across sites
Assess collaborative care vs. usual consult-liaison care for VA patients with depression.Study period 9 months. Recruitment January 1998 to March 1999.Current patient with major depression, dysthymia, or both. Average age 57, 95% male, 80% white.
Control N=186
Intervention N=168
4 clinics in Seattle division of VA-Puget Sound.Depression symptoms, treatment response, remission, QoL, medication utilization.
Katon, 1995 33
RCT
Randomized by patient
Assess collaborative care vs. usual care for adult patients with depression.Study period 12 months. Intervention period up to 9 months. Recruitment not reported.English speaking, current adult patients beginning antidepressants. Average age 48, 76% female.
Control N=109
Intervention N=108
Northgate Medical Center, Group Health Cooperative HMO in western Washington state, a family physician clinic.Depression symptoms, disability, medication adherence, satisfaction, utilization
Katon, 1999 34
RCT
Randomized by patient
Assess stepped collaborative care vs. usual care for adult patients with depression.Study period 6 months. Recruitment not reported.English speaking, current adult patients beginning antidepressants. Average age 47, 75% female, 80% white.
Control N=114
Intervention N=114
4 Group Health Cooperative HMO clinics in Seattle area.Depression symptoms, disability, medication adherence, costs
Katon, 1996 35
RCT
Randomized by patient
Assess collaborative care vs. usual care for adult patients with depression.Study period 6 months. Recruitment not reported.English speaking, current adult patients beginning antidepressants. Average age 46, 74% female, 87% white.
Control N=76
Intervention N=77
Northgate Medical Center, Group Health Cooperative HMO in western Washington state, a family physician clinic.Depression symptoms, disability, medication adherence, costs
Katon, 2001 36, 37
RCT
Randomized by patient
Assess collaborative care vs. usual care for adult patients at risk for depression relapseStudy period 12 months. Recruitment not reported.English speaking, current adult patients beginning antidepressants. Average age 46, 73% female, 90% white.
Control N=192
Intervention N=194
4 Group Health Cooperative HMO clinics in Seattle area.Depression symptoms, depression relapse, medication adherence
Capoccia 2004 38, 39
RCT
Randomized by patient
Assess pharmacist based collaborative care vs. usual care for adults with depressionRecruitment from November 1999 to March 2001. Study period 12 months.English speaking current adult patients beginning antidepressants. Average age 39, 57% female, 22% non-white.
Control N=33
Intervention N=41
Academic family practice clinic in Seattle.Depression symptoms, QoL, medication adherence, utilization, cost.
Tutty, 2000 40
Cohort
Assess telephone counseling and medication monitoring for adult patients with depression.Study period 6 months. Recruitment not reported.Adult patients beginning antidepressants. Average age 47, 69% female.
Control N=94
Intervention N=28
One Group Health Cooperative clinic in Olympia.Depression symptoms, treatment response, remission, adequate dosage.
Hunkeler 2000 41
RCT
Randomized by site
Assess nurse telehealth care vs. usual care for adults with depression.Study period 6 months. Recruitment not reported.English speaking adults with SSRI prescription for depression. About 70% female, 37% non-white.
Control N=123
Intervention N=179
2 Kaiser Permanente clinics in northern CA.Depression symptoms, treatment response, QoL, adherence.
QuEST 42 44
RCT
Randomized by matched site
Assess guideline based depression treatment program vs. usual care for adult patients with depression.Recruitment from April 1996 to September 1997. Study period 2 years.English reading current adult patients with depression. Average age 43, 84% female, 16% non-white.
Control N=240
Intervention N=239
12 practices across U.S. Urban and rural.Depression symptoms, QoL, guideline concordant care.
Simon, 2000 45
RCT
Randomized by patients
Assess feedback only or feedback plus care management vs. usual care for adult patients with depression.Study period 6 months. Intervention period 4 months. Recruitment period not reported.Current adult patients newly prescribed antidepressants. Average age 46 years, 72% female.
Control N=196
Feedback only N=221
FB and care mgmt N=196
5 HMO primary care clinics in Washington stateDepression symptoms, treatment response, remission, adequate dosage, cost
Hilty, 2007 46
RCT
Randomized by patient
Assess usual care depression management with telepsychiatric and PCP training vs. usual care depression management for adult patients with depression.Study period 1 year. 2 year recruitment, period not reported.English speaking current adult patients with depression willing to take antidepressants. Median age 46, 80% female, 10% non-white.
Control N=41
Intervention N=52
8 rural primary care clinics, average 140 miles from UC Davis Medical Center.Depression symptoms, functioning and QoL, satisfaction.
Katzelnick, 2000 47
RCT
Randomization across sites by physician practices
Assess depression management vs. usual care for high utilizers with depression, not in active treatmentStudy period 12 months. Recruitment period not reported.Current adult patients above 85th percentile in utilization for previous 2 years. Average age 45, 77% female, 83% white
Control N=189
Intervention N=218
3 HMOs in the Midwest, Northwest and New England regions, 163 primary care practices.Depression symptoms, treatment response, remission, functioning and QoL, utilization
Anxiety Disorders
Roy-Byrne, 2001 48
RCT
Randomized by patient
Assess collaborative care vs. usual care for adult patients with panic disorder.Study period 12 months. Recruitment not reported.English speaking adult patients with at least one panic attack in last month. Average age 41, 57% female, 67% white.
Control N=58
Intervention N=57
3 urban and suburban group practice clinics in Seattle area, 2 are university associated.Panic, anxiety, and depression symptoms, treatment response, remission, QoL, appropriate medication and dosage, adherence.
CCAP 49, 50
RCT
Randomized by patient, stratified within site
Assess collaborative care vs. usual care for adults with panic disorder.Recruitment March 2000 to March 2002. Study period 1 year.English speaking adult patients with at least one panic attack within last week. Average age 41, 67% female, 66% white
Control N=113
Intervention N=119
University affiliated primary care clinics in Seattle, San Diego, and Los AngelesRemission, treatment response, anxiety sensitivity, depression symptoms, QoL and functional disability, utilization
CALM 51
RCT
Randomized across sites
Assess collaborative care vs. usual care for adult patients with anxiety disorders, including GAD, PTSD, PD, and SADStudy period 18 months. Recruitment not completeEnglish speaking adult current patients with GAD, PTSD, PD and SAD,
N to be1040, 260 at each site
Seattle, WA, Los Angeles and San Diego, CA, and Little Rock, AKAnxiety disorder symptoms, functioning and QoL, satisfaction, utilization. Design only. No results yet
Rollman, 2005 52, 53
RCT
Randomized by patients
Assess telephone-based collaborative care vs. usual care for adult anxiety and panic disorder patients.Recruitment July 2000 to April 2002. Study period 12 monthsEnglish speaking, adult current patients with anxiety disorders. Average age 44 years, 81% female, 95% white.
Control N=75
Intervention N=116
13 PCPs in Pittsburgh area, urban academic, suburban, and rural.Anxiety disorder symptoms, depression symptoms, QoL, utilization, employment status
Price, 2000 54
Matched Cohort
Assess integrated care vs. usual care for adult patients with generalized anxiety disorder (GAD) and GAD secondary to depression.Study period 6 months. Recruitment not reportedEnglish speaking, adult current patients with GAD. Mean age 49 years, 80% female, 86% white.
Control N=111
Intervention N=113
Kaiser Permanente clinics in Westminster, CO. Intervention patients family practice, control patients internal medicineAnxiety symptoms, satisfaction
Other
Katon, 1992 55
RCT
Randomized by patients, stratified by physician and blocked
Assess effect of psychiatric consultation vs. usual care for distressed high utilizers of medical care.Study period 12 months. Recruitment not reported.Top 10% adult ambulatory care utilizers of appropriate age group with psychiatric distress. Average age 47, 61% female.
Control N=127
Intervention N=124
2 primary care clinics of Group Health Cooperative of Puget Sound.Psychiatric distress, functional disability, utilization, use of and adherence to antidepressants
Epstein, 2007 56
RCT
Randomized by pediatricians
Assess collaborative care consultative service for titration and monitoring vs. usual care to improve ADHD care.Study period 1 year. Recruitment not reported.1st through 5th grade children with ADHD
Control N=215
Intervention N=162
12 community-based pediatric practices without onsite psychiatry or psychologist.ADHD symptoms. Titration trials, medication management, dosage, adherence
PRISM-E (for at-risk alcohol use) 4, 5, 57
RCT
Randomized by patients
Assess integrated vs. enhanced referral care for managing at-risk alcohol use in elderly patientsRecruitment March 2000 to March 2002. Study period 6 months (on-going)Elderly primary care patients. 92% male, 70% white, mean age 72
Intervention N=280
Referral N=280
9 practices with 34 urban, suburban, and rural clinics. 5 VA, 2 community health, 2 hospital networks in the Northeast, Miami, and ChicagoDrinking severity, MH QoL, Program use.
Backward Integration
Weisner, 2001 58, 59
RCT
Randomized by patients
Assess integrated vs. usual care for medical and substance abuse careRecruitment April 1997 to December 1998. Study period 6 monthsAdult patients admitted to a chemical dependency program. Mean age 37, 55% male, 74% white.
Control N=307
Intervention N=285
Kaiser Permanente's Chemical Dependency Recovery Program, southern CAAbstinence, treatment utilization. No primary care outcomes
Druss, 2001 60
RCT
Randomized by patients
Willenbring, 1999 61
RCT
Randomized by patients
Assess integrated medical health care vs. usual care for patients with serious mental illnessStudy period 12 months. Recruitment not reported.VA mental health patients without a current primary care provider. Mean age 45, 99% male, 70% white
Control N=61
Intervention N=59
West Haven, CT, VAMCUtilization, quality of preventive care, satisfaction, physical and mental health status, costs
Assess integrated outpatient treatment vs. usual care for alcohol-related medically ill alcohol abuse patientsStudy period 2 years. Recruitment period not reported.VA patients with current alcohol abuse behavior and alcohol-related medical illness. Mean age=55.1
Control N=53
Intervention N=48
Minneapolis, MN VA medical centerDrinking severity, quality of life, utilization

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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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