Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via HighWire Citing Articles via Google Scholar Articles by Bartels, S. J. Search for Related Content PubMed Citation Articles by Bartels, S. J. Geriatric Psychiatry Other Delivery of Care

Improving Access to Geriatric Mental Health Services: A Randomized Trial Comparing Treatment Engagement With Integrated Versus Enhanced Referral Care for Depression, Anxiety, and At-Risk Alcohol Use

OBJECTIVE: The authors sought to determine whether integrated mental health services or enhanced referral to specialty mental health clinics results in greater engagement in mental health/substance abuse services by older primary care patients. METHOD: This multisite randomized trial included 10 sites consisting of primary care and specialty mental health/substance abuse clinics. Primary care patients 65 years old or older (N=24,930) were screened. The final study group consisted of 2,022 patients (mean age=73.5 years; 26% female; 48% ethnic minority) with depression (N=1,390), anxiety (N=70), at-risk alcohol use (N=414), or dual diagnosis (N=148) who were randomly assigned to integrated care (mental health and substance abuse providers co-located in primary care; N=999) or enhanced referral to specialty mental health/substance abuse clinics (i.e., facilitated scheduling, transportation, payment; N=1,023). RESULTS: Seventy-one percent of patients engaged in treatment in the integrated model compared with 49% in the enhanced referral model. Integrated care was associated with more mental health and substance abuse visits per patient (mean=3.04) relative to enhanced referral (mean=1.91). Overall, greater engagement was predicted by integrated care and higher mental distress. For depression, greater engagement was predicted by integrated care and more severe depression. For at-risk alcohol users, greater engagement was predicted by integrated care and more severe problem drinking. For all conditions, greater engagement was associated with closer proximity of mental health/substance abuse services to primary care. CONCLUSIONS: Older primary care patients are more likely to accept collaborative mental health treatment within primary care than in mental health/substance abuse clinics. These results suggest that integrated service arrangements improve access to mental health and substance abuse services for older adults who underuse these services.

This article has been cited by other articles:

				M. Olfson, R. Mojtabai, N. A. Sampson, I. Hwang, B. Druss, P. S. Wang, K. B. Wells, H. A. Pincus, and R. C. Kessler Dropout From Outpatient Mental Health Care in the United States Psychiatr Serv, July 1, 2009; 60(7): 898 - 907. [Abstract] [Full Text] [PDF]

				H. R. Bogner and H. F. de Vries Integration of Depression and Hypertension Treatment: A Pilot, Randomized Controlled Trial Ann. Fam. Med, July 1, 2008; 6(4): 295 - 301. [Abstract] [Full Text] [PDF]

				P. Arean, M. Hegel, S. Vannoy, M.-Y. Fan, and J. Unuzter Effectiveness of Problem-Solving Therapy for Older, Primary Care Patients With Depression: Results From the IMPACT Project Gerontologist, June 1, 2008; 48(3): 311 - 323. [Abstract] [Full Text] [PDF]

				F. Zanjani, S. Mavandadi, T. TenHave, I. Katz, N. B. Durai, D. Krahn, M. Llorente, J. Kirchner, E. Olsen, W. Van Stone, et al. Longitudinal Course of Substance Treatment Benefits in Older Male Veteran At-Risk Drinkers J Gerontol A Biol Sci Med Sci, January 1, 2008; 63(1): 98 - 106. [Abstract] [Full Text] [PDF]

				B. V Watts, B. Shiner, A. Pomerantz, P. Stender, and W. B Weeks Outcomes of a quality improvement project integrating mental health into primary care Qual. Saf. Health Care, October 1, 2007; 16(5): 378 - 381. [Abstract] [Full Text] [PDF]

				P. A. Arean, A. M. Gum, L. Tang, and J. Unutzer Service Use and Outcomes Among Elderly Persons With Low Incomes Being Treated for Depression Psychiatr Serv, August 1, 2007; 58(8): 1057 - 1064. [Abstract] [Full Text] [PDF]

				C. D. Saur, D. C. Steffens, L. H. Harpole, M.-Y. Fan, E. Z. Oddone, and J. Unutzer Satisfaction and Outcomes of Depressed Older Adults With Psychiatric Clinical Nurse Specialists in Primary Care Journal of the American Psychiatric Nurses Association, February 1, 2007; 13(1): 62 - 70. [Abstract] [PDF]

				F. Zanjani, C. Zubritsky, M. Mullahy, and D. Oslin Predictors of Adherence Within an Intervention Research Study of the At-Risk Older Drinker: PRISM-E. J Geriatr Psychiatry Neurol, December 1, 2006; 19(4): 231 - 238. [Abstract] [PDF]

				P. A Arean One in 10 elderly people with minor or subsyndromal depression develops major depression within a year. Evid. Based Ment. Health, November 1, 2006; 9(4): 94 - 94. [Full Text] [PDF]

				D. D. Krahn, S. J. Bartels, E. Coakley, D. W. Oslin, H. Chen, J. McIntyre, H. Chung, J. Maxwell, J. Ware, and S. E. Levkoff PRISM-E: Comparison of Integrated Care and Enhanced Specialty Referral Models in Depression Outcomes Psychiatr Serv, July 1, 2006; 57(7): 946 - 953. [Abstract] [Full Text] [PDF]

				D. W. Oslin, S. Grantham, E. Coakley, J. Maxwell, K. Miles, J. Ware, F. C. Blow, D. D. Krahn, S. J. Bartels, C. Zubritsky, et al. PRISM-E: Comparison of Integrated Care and Enhanced Specialty Referral in Managing At-Risk Alcohol Use Psychiatr Serv, July 1, 2006; 57(7): 954 - 958. [Abstract] [Full Text] [PDF]

				E. M Hunkeler, W. Katon, L. Tang, J. W Williams Jr, K. Kroenke, E. H B Lin, L. H Harpole, P. Arean, S. Levine, L. M Grypma, et al. Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care BMJ, February 4, 2006; 332(7536): 259 - 263. [Abstract] [Full Text] [PDF]

Get information about faster international access.

Privacy Policy

Copyright © 2004 American Psychiatric Association. All rights reserved.

Home | Search | Current Issue | Past Issues | Subscribe | All APPI Journals | Help | Contact Us