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

Article Figures & Data

Table 1.

Clinicians Preferring Integrated Care to Enhanced Referral Care According to Aspects of Treatment of Mental Health Problems

Treatment Aspect	*Integrated Care PreferredNo. (%)**	PValue^†
* Some data missing due to item nonresponse.
† P values represent the statistical test for whether the proportion preferring integrated care equaled 50%.
Better communication	113 (92.6)	<.0001
More comprehensive services	74 (61.7)	.0106
Better management of depression	77 (64.2)	.0019
Better management of anxiety	91 (75.8)	<.0001
Better management of alcohol abuse	78 (65.5)	<.001
More convenient services for patients	106 (87.6)	<.0001
Less stigma for patients	111 (92.5)	<.0001
Better coordination of mental and physical care	109 (91.6)	<.0001
Quicker appointments for mental health	102 (85.7)	<.0001
Better health education	102 (88)	<.0001

Table 2.

Clinician Rating of Communication Between Clinicians and MH/SA Specialists, by Clinician Participation in Management

Areas Clinicians More Likely to Agree Frequent Communication Occurs	Participates in Counseling OR (95% CI)	Participates in Psychopharmacology Management OR (95% CI)
CI = confidence interval; OR = odds ratio; MH/SA = mental health/substance abuse.
Note: Rated by the clinicians who experienced the integrated care model.
Results of MH/SA diagnosis	8.2 (2.5–26)	7.8 (2.4–25)
Medical diagnosis, condition	1.5 (0.52–4.4)	1.8 (0.67–4.9)
Medical care plan	1.4 (0.52–3.9)	0.97 (0.36–2.6)
MH/SA care plan	3.5 (1.2–10.6)	4.3 (1.5–12.7)
MH/SA progress and follow-up	3.3 (1.1–9.2)	2.9 (1.1–7.9)

The Article in Brief

A recent study compared 2 approaches for treating older adults for depression and other mental health problems. In one approach (called "integrated care"), a mental health or substance abuse specialist was located in the same practice as the patient's primary care doctor. In the other approach (called "referral care"), patients were referred to a separate mental health or substance abuse clinic, with transportation and case management provided. Most primary care doctors in the study preferred the integrated care approach. They felt it led to better communication between doctors and mental health specialists, was more convenient for patients, and that patients were less stigmatized.