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

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• 作者：Benjamin G. Druss and Silke A. von Esenwein
• 刊名：General Hospital Psychiatry
• 出版年：2006
• 出版时间：March-April 2006
• 年：2006
• 卷：28
• 期：2
• 页码：145-153
• 全文大小：194 K

文摘

Objective

To conduct a systematic review of studies of interventions designed to improve general medical care in persons with mental and addictive disorders.

Methods

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.

Results

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.

Conclusion

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. Future work should continue to develop and test approaches to this problem that can be tailored to local system needs and capacities.