A randomized trial of psychiatric consultation with distressed high utilizers.
This study reports the results of a randomized trial of a psychiatric consultation intervention with distressed, high utilizing patients of 18 physicians in two primary care clinics. Psychiatric consultation was associated with a significant increase in the use of antidepressants in intervention patients compared with controls in the first 6 months after intervention. Intervention patients were also significantly more likely to continue antidepressant treatment than control patients. The primary care physicians receiving psychiatric consultations increased the rate of prescribing antidepressant medications in their practice from 32 prescriptions filled per 1,000 visits before their participation in four consultations to 44 new prescriptions per 1,000 visits in the 12-month period after. There were no significant differences between intervention patients and controls at 6 and 12 months after randomization in psychiatric distress, functional disability, or utilization of health care (ambulatory visits, radiographic and laboratory testing services, admissions to inpatient medical care).
Katon
W
W
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle 98195.
Von Korff
M
M
Lin
E
E
Bush
T
T
Russo
J
J
Lipscomb
P
P
Wagner
E
E
D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data*; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy; D003363:Cost Control / Q000639:trends; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy; D005500:Follow-Up Studies; D006279:Health Maintenance Organizations / Q000191:economics / Q000706:statistics & numerical data; D006300:Health Services Misuse / Q000191:economics*; D006801:Humans; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D010348:Patient Care Team / Q000191:economics / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data; D011602:Psychophysiologic Disorders / Q000523:psychology / Q000628:therapy; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data; D013001:Somatoform Disorders / Q000523:psychology / Q000628:therapy; D014861:Washington