OBJECTIVE: To conduct a systematic review of studies of interventions designed to improve general medical care in persons with mental and addictive disorders. METHODS: Following Cochrane Collaboration guidelines, a comprehensive search through October 2005 was conducted in multiple bibliometric indexes using search terms related to primary medical care and mental health/addictive disorders. Two assessors independently extracted information on linkage, quality, outcomes and costs of care. RESULTS: Six randomized trials met the preestablished search criteria. The interventions spanned a continuum of approaches for improving treatment, ranging from on-site medical consultation, through team-based approaches, to models involving facilitated referrals to primary care. The studies demonstrated a substantial positive impact on linkage to and quality of medical care; there was evidence of health improvement and improved abstinence rates in patients with greater medical comorbidity. The three studies that assessed expenditures found the programs to be cost-neutral from a health-plan perspective. CONCLUSION: A small but growing body of research suggests that a range of models may hold potential for improving these patients' health and health care, at a relatively modest cost. Future work should continue to develop and test approaches to this problem that can be tailored to local system needs and capacities.
Continuity of patient care is frequently linked to quality care outcomes. The purpose of this paper is to examine the clinical trial literature in order to determine the extent to which informational, management, and relational continuity of care are associated with quality care indicators. A MEDLINE search of the literature via PubMed was conducted for clinical trials that were carried out from 1 January 1996-1 June 2005. Analyses of 32 unduplicated citations revealed a focus on one or more aspects of continuity and its association with quality care outcomes. Management continuity interventions were identified most often, followed by informational and relational continuity interventions. The outcomes were primarily patient-focused with a wide range of functional status, quality of life, and patient satisfaction indicators. This analysis provides implications for research that could contribute to an understanding of the types of continuity of patient care and their relationships to quality care.
To conduct a systematic review of studies of interventions designed to improve general medical care in persons with mental and addictive disorders.
METHODS:
Following Cochrane Collaboration guidelines, a comprehensive search through October 2005 was conducted in multiple bibliometric indexes using search terms related to primary medical care and mental health/addictive disorders. Two assessors independently extracted information on linkage, quality, outcomes and costs of care.
RESULTS:
Six randomized trials met the preestablished search criteria. The interventions spanned a continuum of approaches for improving treatment, ranging from on-site medical consultation, through team-based approaches, to models involving facilitated referrals to primary care. The studies demonstrated a substantial positive impact on linkage to and quality of medical care; there was evidence of health improvement and improved abstinence rates in patients with greater medical comorbidity. The three studies that assessed expenditures found the programs to be cost-neutral from a health-plan perspective.
CONCLUSION:
A small but growing body of research suggests that a range of models may hold potential for improving these patients' health and health care, at a relatively modest cost. Future work should continue to develop and test approaches to this problem that can be tailored to local system needs and capacities.
