Performance Improvement 2008. Do Patients Who Are Depressed or Who Suffer At-Risk-Drinking Fare Better in Integrated Primary Care Settings or in Specialty Care?


The multi-site study compared the effectiveness of service delivery models that treat older adults with mental health or substance abuse problems. The study identified differences in clinical and cost outcomes between treatment models providing consumers with specialty mental health and substance abuse services within the primary care settings (integrated model) and models referring consumers outside the primary care setting (referral model). This four-year randomized controlled trial included 3,000 patients with problems who were assigned to one of the two models of care. The study found that participants were more open to receiving care within primary care than in specialty clinics. For depression, both the integrated primary care and specialty referral care groups saw significant improvements in rates of remission and symptom reduction. However, for the subgroup with major depression, referral to specialty care was better at lessening the severity of symptoms. For at risk drinking, both the primary care and the specialty care improved client health conditions by reducing the number of drinks per week and decreasing binge drinking. The initiative included the active collaboration of all three SAMHSA centers, with the Center for Mental Health Services (CMHS) as the lead, the Health Resource Services Administration's Bureau of Primary Care, the Department of Veterans Affairs, and the Centers for Medicaid and Medicare Services.

Report Title: Outcome Findings for Mental Health and At-Risk Drinking from the Primary Care Research in Substance Use and Mental Health for the Elderly Multisite Study (PRISM-E)
Agency Sponsor: SAMHSA, Substance Abuse and Mental Health Services Administration
Federal Contact: Marian Scheinholtz, 240-276-1911
Performer: Center for Mental Health Services, (SAMHSA), HHS

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"PerformanceImprovement2008.pdf" (pdf, 1.29Mb)

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