Improving general medical care for persons with mental and addictive disorders: systematic review

General Hospital Psychiatry
Benjamin Druss, Silke A von Esenwein

Abstract

To conduct a systematic review of studies of interventions designed to improve general medical care in persons with mental and addictive disorders. Following Cochrane Collaboration guidelines, a comprehensive search through October 2005 was conducted in multiple bibliometric indexes using search terms related to primary medical care and mental health/addictive disorders. Two assessors independently extracted information on linkage, quality, outcomes and costs of care. Six randomized trials met the preestablished search criteria. The interventions spanned a continuum of approaches for improving treatment, ranging from on-site medical consultation, through team-based approaches, to models involving facilitated referrals to primary care. The studies demonstrated a substantial positive impact on linkage to and quality of medical care; there was evidence of health improvement and improved abstinence rates in patients with greater medical comorbidity. The three studies that assessed expenditures found the programs to be cost-neutral from a health-plan perspective. A small but growing body of research suggests that a range of models may hold potential for improving these patients' health and health care, at a relatively modest cost. F...Continue Reading

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