title: PRISM-E: comparison of integrated care and enhanced specialty referral models in depression outcomes.
abstract: OBJECTIVE
  This study, entitled Primary Care Research in Substance Abuse and Mental Health for the Elderly, examined six-month outcomes for older primary care patients with depression who received different models of treatment.
  
  
  METHODS
  Clinical outcomes were compared for patients who were randomly assigned to integrated care or enhanced specialty referral. Integrated care consisted of mental health services co-located in primary care in collaboration with primary care physicians. Enhanced specialty referral consisted of referral to physically separate, clearly identified mental health or substance abuse clinics.
  
  
  RESULTS
  A total of 1,531 patients were included; their mean age was 73.9 years. Remission rates and symptom reduction for all depressive disorders were similar for the two models at the three- and six-month follow-ups. For the subgroup with major depression, the enhanced specialty referral model was associated with a greater reduction in depression severity than integrated care, but rates of remission and change in function did not differ across models of care for major depression.
  
  
  CONCLUSIONS
  Six-month outcomes were comparable for the two models. For the subgroup with major depression, reduction in symptom severity was superior for those randomly assigned to the enhanced specialty referral group.
authors.affiliation: Department of Psychiatry, William S. Middleton Memorial Veterans Hospital, Madison, WI 53705, USA. dean.krahn@med.va.gov
authors.forename: Dean D
authors.initials: DD
authors.lastname: Krahn
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Bartels
authors.forename: Eugenie
authors.initials: E
authors.lastname: Coakley
authors.forename: David W
authors.initials: DW
authors.lastname: Oslin
authors.forename: Hongtu
authors.initials: H
authors.lastname: Chen
authors.forename: Jack
authors.initials: J
authors.lastname: McIntyre
authors.forename: Henry
authors.initials: H
authors.lastname: Chung
authors.forename: James
authors.initials: J
authors.lastname: Maxwell
authors.forename: James
authors.initials: J
authors.lastname: Ware
authors.forename: Sue E
authors.initials: SE
authors.lastname: Levkoff
mesh_terms: D000368:Aged; D000437:Alcoholism / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation; D015897:Comorbidity; D019033:Delivery of Health Care, Integrated; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D010348:Patient Care Team; D011320:Primary Health Care; D012017:Referral and Consultation; D016896:Treatment Outcome; D014481:United States