Table 3.
Outcomes for studies on integrated delivery of mental health and substance abuse services
| Type of outcome | Study | Measure | Outcome (Intervention vs. Control) |
|---|---|---|---|
| Health outcomes | Druss 2001 | Change in physical component summary index. | +4.7% vs. -0.3%, (p < 0.001) |
| Change in mental component summary index. | +2.4% vs. +2%, (p = 0.84) | ||
| Krahn 2006 | Change in Centre for Epidemiological Studies Depression scale (CES-D) score. | Patients with all depression: -6.0 ± 12.0 vs. -7.8 ± 11.8, (p = 0.07) |
|
| Patients with major depression: -7.5 ± 13.1 vs. -10.2 ± 12.1, (p = 0.003) |
|||
| Change in Medical Component Score (MCS). | Patients with all depression: +4.8 ± 12.6 vs. +4.9 ± 12.9, (p = 0.88) |
||
| Patients with major depression: +5.9 ± 12.6 vs. + 6.8 ± 12.8, (p = 0.32) |
|||
| Willenbring 1999 | Number of patients with 2-year survival. | 31/38 (81%) vs. 26/37 (70%), (p = 0.03) | |
| Drug and alcohol use | Oslin 2006 | Change in number of drinks per week. | -6.0 vs. -5.9 (p = 0.913) |
| Change in number of binge episodes in the preceding three months. | -8.5 vs. -10.2 (p = 0.750) | ||
| Weisner 2001 | Total abstinence and duration of abstinence. | Non-SAMC patients: 66% vs. 73%, (p = 0.23) |
|
| SAMC patients: 69% vs. 55%, (p = 0.006); period of abstinence 135 days vs. 122 days, (p = 0.05) |
|||
| Alcohol abstinence. | Non-SAMC patients: 73% vs. 78% (p = 0.41) |
||
| SAMC patients: 80% vs. 65%, (p = 0.002) |
|||
| Other drug abstinence | Non-SAMC patients: 84% vs. 87%, (p = 0.50) |
||
| Willenbring 1999 | Number of patients with alcohol abstinence after 2 years. | 28/38 (74%) vs. 17/36 (48%), (p = 0.02) | |
| Patient satisfaction | Druss 2001 | Satisfaction score on 47-item questionnaire. | Patients in integrated model were more satisfied with overall care received in 6 of 8 domains (access, attention to patient preferences, courtesy, coordination, continuity, and overall care) (p < 0.05 on all 6 domains) |
| Gater 1997 | Score on Client Satisfaction Questionnaire (range 1-4; low score indicates higher satisfaction). | 1.86 vs. 2.23 | |
| Quality of care | Druss 2001 | Delivery of preventive measures outlined in clinical guidelines. | Patients in integrated model (n = 59) more likely than in control group (n = 61) to receive 15 of 17 measures, (p < 0.01) |
| Gater 1997 | Number of clinical needs met; and unmet. | 2.62 vs. 1.60, (p < 0.001); 0.57 vs. 1.62 (p < 0.001) |
|
| Number of social needs met; and unmet. | 1.83 vs. 1.49, (p = NS); 0.86 vs. 1.64 (p < 0.05) | ||
| Watts 2007 | Patients who screened positive for depression and received treatment in accordance with guidelines. | From 1.1% to 11.2% vs. from 3.0% to 0.7%, (p < 0.001) | |
| Utilisation of services | Bartels 2004 | Mean number of mental health and substance abuse visits. | 3.04 vs. 1.91 (p ≤ 0.001) |
| Appointment attendance. | 71% vs. 48.8% (95% CI = 2.14 to 3.08) | ||
| Druss 2001 | Patients who used a medical: Primary care service; Specialty service; Emergency department; Inpatient service. |
54/59 (91.5%) vs. 44/61 (72.1%), (p = 0.006); 41/59 (69.5%) vs. 41/61 (67.2%), (p = 0.17); 7/59 (11.9%) vs. 16/61 (26.2%), (p = 0.04); 5/59 (8.5%) vs. 11/61 (18%), (p = 0.12) |
|
| Patients who used a mental health: Outpatient service; Emergency department; Inpatient service. |
58/59 (98.3%) vs. 61/61 (100%), (p = 0.31); 21/59 (35.6%) vs. 25/61 (41%), (p = 0.31); 8/59 (13.6%) vs. 10/61 (16.4%), (p = 0.66) |
||
| Willenbring 1999 | Mean number of IOT visits in 2 years. | 42.2 ± 29.1 vs. 17.4 ± 15.6, (p < 0.001) | |
| Mean number of IOT visits in first and last 6 months of treatment. | From 14 to 9 vs. 4-6 in both periods | ||
| Access to health care | Watts 2007 | Patients who screened positive and were able to access mental health services. | 36.0% vs. 9%, (p < 0.001) |
| Cost | Druss 2001 | Mean cost per subject treated | US$ 13,010 vs. US$ 14,543 |
| Gater 1997 | Overall per capita health service cost | £ 1,406 vs. £ 1,199 | |
| Weisner 2001 | Average cost of all treatment per month | US$ 470.81 vs. US$ 427.95, (p = 0.14) | |