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Research ArticleOriginal Research

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

Joseph J. Gallo, Cynthia Zubritsky, James Maxwell, Michael Nazar, Hillary R. Bogner, Louise M. Quijano, Heidi J. Syropoulos, Karen L. Cheal, Hongtu Chen, Herman Sanchez, John Dodson, Sue E. Levkoff and The Prism-E Investigators
The Annals of Family Medicine July 2004, 2 (4) 305-309; DOI: https://doi.org/10.1370/afm.116
Joseph J. Gallo
MD, MPH
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Cynthia Zubritsky
PhD
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James Maxwell
PhD
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Michael Nazar
MD
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Hillary R. Bogner
MD, MSCE
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Louise M. Quijano
CSW-R
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Heidi J. Syropoulos
MD, CMD
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Karen L. Cheal
MPH
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Hongtu Chen
PhD
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Herman Sanchez
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John Dodson
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Sue E. Levkoff
ScD
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    Table 1.

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

    Treatment AspectIntegrated Care Preferred*No. (%)PValue†
    * Some data missing due to item nonresponse.
    † P values represent the statistical test for whether the proportion preferring integrated care equaled 50%.
    Better communication113 (92.6)<.0001
    More comprehensive services74 (61.7).0106
    Better management of depression77 (64.2).0019
    Better management of anxiety91 (75.8)<.0001
    Better management of alcohol abuse78 (65.5)<.001
    More convenient services for patients106 (87.6)<.0001
    Less stigma for patients111 (92.5)<.0001
    Better coordination of mental and physical care109 (91.6)<.0001
    Quicker appointments for mental health102 (85.7)<.0001
    Better health education102 (88)<.0001
    • View popup
    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 OccursParticipates 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 diagnosis8.2 (2.5–26)7.8 (2.4–25)
    Medical diagnosis, condition1.5 (0.52–4.4)1.8 (0.67–4.9)
    Medical care plan1.4 (0.52–3.9)0.97 (0.36–2.6)
    MH/SA care plan3.5 (1.2–10.6)4.3 (1.5–12.7)
    MH/SA progress and follow-up3.3 (1.1–9.2)2.9 (1.1–7.9)

Additional Files

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  • 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.

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The Annals of Family Medicine: 2 (4)
The Annals of Family Medicine: 2 (4)
Vol. 2, Issue 4
1 Jul 2004
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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)
Joseph J. Gallo, Cynthia Zubritsky, James Maxwell, Michael Nazar, Hillary R. Bogner, Louise M. Quijano, Heidi J. Syropoulos, Karen L. Cheal, Hongtu Chen, Herman Sanchez, John Dodson, Sue E. Levkoff, The Prism-E Investigators
The Annals of Family Medicine Jul 2004, 2 (4) 305-309; DOI: 10.1370/afm.116

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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)
Joseph J. Gallo, Cynthia Zubritsky, James Maxwell, Michael Nazar, Hillary R. Bogner, Louise M. Quijano, Heidi J. Syropoulos, Karen L. Cheal, Hongtu Chen, Herman Sanchez, John Dodson, Sue E. Levkoff, The Prism-E Investigators
The Annals of Family Medicine Jul 2004, 2 (4) 305-309; DOI: 10.1370/afm.116
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Subjects

  • Domains of illness & health:
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  • Methods:
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  • Core values of primary care:
    • Coordination / integration of care
  • Other topics:
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