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Does Integrated Care Improve Treatment for Depression?: A Systematic Review

Butler, Mary PhD, MBA; Kane, Robert L. MD; McAlpine, Donna PhD; Kathol, Roger MD; Fu, Steven S. MD, MSCE; Hagedorn, Hildi PhD; Wilt, Timothy MD, MPH

Journal of Ambulatory Care Management: April/June 2011 - Volume 34 - Issue 2 - p 113–125
doi: 10.1097/JAC.0b013e31820ef605
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Care management–based interventions promoting integrated care by combining primary care with mental health services in a coordinated and colocated manner are increasingly popular; yet, the benefits of specific approaches are not well established. We conducted a systematic review of integrated care trials in US primary care settings to assess whether the level of integration of provider roles or care process affects clinical outcomes. Although most trials showed positive effects, the degree of integration was not significantly related to depression outcomes. Integrated care appears to improve depression management in primary care patients, but questions remain about its specific form and implementation.

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Author Affiliations: Minnesota Evidence-based Practice Center (Drs Butler, Kane, McAlpine, and Wilt), University of Minnesota School of Public Health (Drs Butler, Kane, and McAlpine), University of Minnesota Medical School, Department of Psychiatry (Drs Kathol and Hagedorn), University of Minnesota Medical School, Department of Medicine (Drs Kathol, Fu, and Wilt), and Minneapolis VA Center for Chronic Disease Outcomes Research (Drs Fu, Hagedorn, and Wilt), Minneapolis, Minnesota.

Mary Butler and Donna McAlpine had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Robert Kane consults for Medtronic, United Healthgroup, SCAN and the Lewin Group.

This work was derived from the report “Integration of Mental Health/Substance Abuse and Primary Care” supported by a contract to the Minnesota Evidence-Based Practice Center from the Agency for Healthcare Research and Policy.

Funding and Disclaimers: This project was funded under Contract No. 290-02-0009, Task Order No. 7 from the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services. This topic was collaboratively nominated by the Substance Abuse and Mental Health Services Administration (SAMHSA), Health Resources and Services Administration (HRSA), and the Centers for Medicare & Medicaid Services (CMS), and selected by AHRQ for systematic review by an evidence-based practice center. A representative from AHRQ served as a task order officer and provided technical assistance during the conduct of the full evidence report and provided comments on draft versions of the full evidence report. AHRQ did not directly participate in the literature search, determination of study eligibility criteria, data analysis or interpretation, or preparation, review, or approval of the manuscript for publication. The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by AHRQ or the US Department of Health and Human Services.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.ambulatorycaremanagement.com).

Correspondence: Mary Butler, PhD, MBA, University of Minnesota School of Public Health, 420 Delaware St SE, MMC 197, Minneapolis, MN 55455 (butl0092@umn.edu).

© 2011 Lippincott Williams & Wilkins, Inc.