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Primary Care Clinicians Evaluate Integrated and Referral Models of Behavioral Health Care For Older Adults: Results From a Multisite Effectiveness Trial (PRISM-E)

¹ Department of Family Practice and Community Medicine, University of Pennsylvania, Philadelphia, Pa
² Center for Mental Health Policy and Research, University of Pennsylvania, Philadelphia, Pa
³ JSI Research and Training Institute, Boston, Mass
⁴ Unity Health System, Rochester, NY
⁵ Unity Health System, Cypress, Tex
⁶ Cleveland Clinic Florida, Weston, Fla
⁷ Department of Psychiatry, Brigham and Women’s Hospital, Boston, Mass

CORRESPONDING AUTHOR: Joseph J. Gallo, MD, MPH, Department of Family Practice and Community Medicine, University of Pennsylvania, 3400 Spruce Street, 2 Gates Building Philadelphia, PA 19104, jjgallo{at}mail.med.upenn.edu

BACKGROUND Recent studies have shown that integrated behavioral health services for older adults in primary care improves health outcomes. No study, however, has asked the opinions of clinicians whose patients actually experienced integrated rather than enhanced referral care for depression and other conditions.

METHOD The Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISM-E) study was a randomized trial comparing integrated behavioral health care with enhanced referral care in primary care settings across the United States. Primary care clinicians at each participating site were asked whether integrated or enhanced referral care was preferred across a variety of components of care. Managers also completed questionnaires related to the process of care at each site.

RESULTS Almost all primary care clinicians (n = 127) stated that integrated care led to better communication between primary care clinicians and mental health specialists (93%), less stigma for patients (93%), and better coordination of mental and physical care (92%). Fewer thought that integrated care led to better management of depression (64%), anxiety (76%), or alcohol problems (66%). At sites in which the clinicians were rated as participating in mental health care, integrated care was highly rated as improving communication between specialists in mental health and primary care.

CONCLUSIONS Among primary care clinicians who cared for patients that received integrated care or enhanced referral care, integrated care was preferred for many aspects of mental health care.

Key Words: Aged • depression • primary health care • health knowledge, attitudes, practice • professional practice • substance-related disorders/therapy • health services for the aged

This article has been cited by other articles:

				J. J. Gallo, H. R. Bogner, K. H. Morales, E. P. Post, J. Y. Lin, and M. L. Bruce The Effect of a Primary Care Practice-Based Depression Intervention on Mortality in Older Adults: A Randomized Trial Ann Intern Med, May 15, 2007; 146(10): 689 - 698. [Abstract] [Full Text] [PDF]

				K. C. Stange In This Issue: Practice Change and Patient Safety Ann. Fam. Med, July 1, 2004; 2(4): 290 - 291. [Full Text] [PDF]

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