New, Notable Integration Research and Resources
Healthcare research evolves at a rapid pace. Literature on the integration of primary and behavioral health care, in particular, seems to evolve daily — and with new integration efforts emerging in communities nationwide, the need for this research is even greater.
As a “national home” of integration, the SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) harvests a variety of new, notable, and seminal research related to integrated health services design and provision, consumer experience, and cost. As such, the below compilation represents recent and noteworthy journal articles that have emerged over the past several months — though the list is far from exhaustive. To regularly view the evolving research supporting integration, visit the Agency for Healthcare Research and Quality’s Academy for Integrating Behavioral Health and Primary Care.
Please also take a moment to read a recent blog entry by National Institute of Mental Health Director Thomas Insel, Top Ten Research Advances of 2012, in which he provides a summation of the most important mental health research over the past year.
Many research resources require membership or payment to view complete articles. In addition, the following references are for informational purposes and do not constitute endorsement or recommendation by SAMHSA or HRSA.
- Integrated Care Outcomes
- Co-occuring Physical & Behavioral Health Conditions
- Mental Illness
- Alcohol Use
- Substance Use & Treatment
- Tobacco Cessation
- Cost Savings and Utilization Reduction
Primary Care Behavioral Health Consultation Reduces Depression Levels among Mood-Disordered Patients, Journal of Health Disparities for Research and Practice, 2012.
Integrated behavioral healthcare is associated with reductions in both self-reported levels of depression and the rate of high-cost medical visits. This provides additional support for integrated behavioral health consultative care as an efficacious and cost effective healthcare model.
Comparative Effectiveness of Collaborative Chronic Care Models for Mental Health Conditions across Primary, Specialty, and Behavioral Health Care Settings: Systematic Review and Meta-Analysis, American Journal of Psychiatry, 2012.
Collaborative chronic care models can improve mental and physical outcomes for individuals with mental disorders across a wide variety of care settings, and they provide a robust clinical and policy framework for care integration.
Collaborative Care Teams Improve Mental Health Outcomes, Cochrane Database of Systematic Reviews, 2012
This review demonstrates that collaborative care involving multiple clinicians significantly improves depression and anxiety outcomes when compared to standard care from a primary care physician. This care typically involves improved intercommunication between clinicians, a structured treatment plan, and scheduled patient follow-ups.
What is needed to deliver collaborative care to address comorbidity more effectively for adults with a severe mental illness? Australian and New Zealand Journal of Psychiatry, 2012
This literature asserts that cross-sector collaboration is achievable and can result in significant benefits for consumers and staff of collaborating services.
ADHD with comorbid substance use disorder: review of treatment, Advances in Psychiatric Treatment, 2012
This review explores the relationship between adult attention-deficit hyperactivity disorder ADHD and substance use disorder, including use of legal and illicit substances such as nicotine, alcohol, cocaine, and cannabis.
Mental and Physical Health-Related Quality of Life among U.S. Cancer Survivors: Population Estimates from the 2010 National Health Interview Survey, Cancer Epidemiology, Biomarkers and Prevention, 2012
These data explain the burden of cancer diagnosis and treatment on U.S. survivors and can be used to monitor the impact of national efforts to improve survivorship care and outcomes.
Cancer Incidence in a Sample of Maryland Residents with Serious Mental Illness, Psychiatric Services, 2012.
People with serious mental illnesses have an increased mortality rate and a higher burden of many medical conditions compared with those without serious mental illnesses. Cancer incidence was examined by race, sex, and cancer site in a community-based cohort of adults with schizophrenia or bipolar disorder. However, cancer risk in this population is uncertain.
The Role of Adverse Physical Health Events on the Utilization of Mental Health Services, Health Services Research, 2012.
An adverse physical health event is significantly associated with a more than threefold increase in provider visits and prescribed medication use for the treatment of mental health problems. These increases are mainly through office-based physician visits for nonsevere mental health conditions. This relationship is greater among those who experience more severe physical health problems.
Association between Psychological Distress And Mortality: Individual Participant Pooled Analysis of 10 Prospective Cohort Studies, British Medical Journal, 2012.
Psychological distress is associated with increased risk of mortality from several major causes in a dose-response pattern. Risk of mortality was raised even at lower distress levels.
Common Mental Disorders and Long-Term Sickness Absence in a General Working Population: The Hordaland Health Study, Acta Psychiatrica Scandinavica, 2012.
Common mental disorders are long-lasting predictors of onset, duration, and recurrence of substance abuse. Anxiety appears to be a more important contributor to long-term substance abuse than previously described in literature.
Life expectancy gap widens between those with mental illness and general population
Research: David Lawrence, Telethon Institute for Child Health Research, The University of Western Australia via Liz Chester (Press Office), 2013
The gap between life expectancy in patients with a mental illness and the general population has widened since 1985 and efforts to reduce this gap should focus on improving physical health. Researchers find that there have been significant advances in reducing death rates due to common physical conditions, but people with mental illness have not benefited to the same extent as the general population.
Effect of Telephone-Administered vs. Face-to-face Cognitive Behavioral Therapy on Adherence to Therapy and Depression Outcomes among Primary Care Patients: A Randomized Trial, The Journal of the American Medical Association, 2012.
Among primary care patients with depression, providing cognitive behavioral therapy (CBT) via telephone compared with face-to-face resulted in lower attrition and close to equivalent improvement in depression at posttreatment. At 6-month follow-up, patients remained less depressed, but were more depressed than those receiving face-to-face CBT. Thus, CBT by telephone improves adherence compared with face-to-face delivery, but at the cost of some increased risk of poorer maintenance of gains after treatment cessation.
Widening Access to Treatment for Alcohol Misuse: Description and Formative Evaluation of an Innovative Web-Based Service in One Primary Care Trust, Alcohol and Alcoholism, 2012.
Employing web-based services for people with substance use problems in primary care was found to be feasible and acceptable to patients, primary care professionals, and commissioners. Users appeared to reduce their alcohol consumption. This model may be of interest to primary care commissioners looking to increase access to alcohol treatments at low cost.
The 5-item Alcohol Use Disorders Identification Test (AUDIT-5): An Effective Brief Screening Test for Problem Drinking, Alcohol Use Disorders, and Alcohol Dependence, Alcohol and Alcoholism, 2012.
AUDIT-5 was found to be very effective in screening for problem drinking, alcohol use disorders, and alcohol dependence among Korean males in clinical settings.
Entry Into Primary Care-Based Buprenorphine Treatment is Associated with Identification and Treatment of Other Chronic Medical Problems, Addiction Science & Clinical Practice, 2012
According to this research, offering Buprenorphine treatment in a primary care setting may facilitate identification and treatment of other chronic medical conditions.
Highlights of the 2010 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits, Drug Abuse Warning Network (DAWN), 2012
DAWN data demonstrate the increasing involvement of pharmaceuticals in emergency department visits related to both drug use and adverse reactions.
The Cigarette Smoking and Mental Illness: A Study of Nicotine Withdrawal provides many clinical implications and supports the idea that in the mental health setting (where the diagnosis of nicotine withdrawal is often missed) that we are treating these non-specific symptoms of anxiety and agitation with far more dangerous drugs than nicotine replacement.
A Qualitative Examination of the Positive and Negative Consequences Associated With Going Tobacco-Free in Substance Abuse Treatment: The NY State Experience, Nicotine and Tobacco Research, 2012
The examination identified a range of positive and negative consequences of tobacco-free regulations in New York. The most commonly reported positive outcomes were positive behavior change (e.g., less smoking, increased intentions to quit) and increased awareness about smoking (e.g., dangers, available assistance to quit). The most commonly reported negative consequences were reinforcing addict behaviors among patients (e.g., lying, “dealing” cigarettes) and enforcement problems (e.g., difficulty enforcing, policing for compliance).
Sustainment of Smoking Cessation Programs in Substance Use Disorder Treatment Organizations, Nicotine and Tobacco Research, 2012
These findings provided empirical support on the importance of leadership and staff expertise in sustaining innovations over time. Although the majority of substance use treatment organizations sustained their smoking cessation programs, a 40% discontinuation rate highlights the ongoing challenges faced by tobacco control efforts in substance abuse treatment.
Demonstrating a Return on Investment for Integrated Substance Abuse Treatment and Medical Care Management, Center for Health Care Strategies, 2006
Johns Hopkins HealthCare analyzed the return on investment on integrating substance abuse services and medical care management for Medicaid recipients. Data showed a significant cost savings per participant and a positive return on investment.
Cost-effectiveness of a Multicondition Collaborative Care Intervention, JAMA Psychiatry, 2012
A two-year cost-effectiveness analysis of depression interventions integrated into primary care to improve the health of those with comorbid depression and diabetes, heart disease, or both found that the program added little to no additional cost while markedly improving quality-adjusted life years.
Long-term Cost Effects of Collaborative Care for Late-life Depression, American Journal of Managed Care, 2008
The Improving Mood: Promoting Access to Collaborative Treatment (IMPACT) trial, conducted in primary care practices across the United States, enrolled 1,801 patients 60 years or older who have depression to determine the long-term effect on total health care costs. Compared with usual primary care, the IMPACT program is associated with a high probability of lower total health care costs during a 4-year period.
The Patient-Centered Medical Home's Impact on Cost and Quality:
Annual Review of Evidence, 2014-2015
This review provides a summary of patient-centered medical home cost and utilization results from peer-reviewed studies, state government evaluations, industry reports, and independent federal program evaluations published between October 2014 and November 2015.