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


CONCLUSIONS
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.
Druss
Benjamin G
BG
Rollins School of Public Health, Emory University, Atlanta GA 30322, USA. bdruss@emory.edu
von Esenwein
Silke A
SA
D016739:Behavior, Addictive; D005194:Family Practice; D006801:Humans; D001523:Mental Disorders; D010361:Patients / Q000523:psychology; D011787:Quality of Health Care; D016032:Randomized Controlled Trials as Topic; D017749:Total Quality Management; D014481:United States