***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Recent national guidelines emphasize the requirement for all general practitioners to manage drug users within a shared care scheme and suggest that a primary health care liaison worker ( PHCLW ) may facilitate these arrangements . We undertook a group-r and omized , r and omized controlled trial to determine the effectiveness of a PHCLW in promoting shared care . METHODS Primary health care teams in Stockport Health Authority , North West Engl and , were r and omly allocated to either an intervention arm , who were offered the services of a PHCLW , or to a control arm , who were offered st and ard support from the community drug team ( CDT ) . The proportion of CDT clients with a history of regular opiate misuse  who were in shared care 12 months after r and omization was compared across study arms . RESULTS Eighteen ( 24.0 per cent ) of the 75 CDT clients in the intervention arm but none of the 80 CDT clients in the control arm were in shared care at 12 months ( chi2 = 9.37 , df = 1 , p < 0.01 ; 95 per cent confidence interval 8.6 - 39.4 per cent ) . CONCLUSION A PHCLW can significantly increase the number of CDT clients  in shared care arrangements Papers p 1135 This week we publish an  economic evaluation  of screening for abdominal aortic aneurysms.1 It is based on a r and omised trial . At the same time the Lancet is publishing the clinical results .2 Unfortunately this is a common pattern — for the Lancet to publish the clinical results and us to publish the economic evaluation . We have decided that this ca n't continue . We will now consider for publication  economic evaluations based on clinical trials only if the clinical results are su bmi tted to us as well . This is partly petulance , but we think our policy is reasonable . The clinical world Background : Specialist medical practitioners have conducted clinics in primary care and rural hospital setting s for a variety of reasons in many different countries . Such clinics have been regarded as an important policy option for increasing the accessibility and effectiveness of specialist services and their integration with primary care services . Objectives : To undertake a descriptive overview of studies of specialist outreach clinics and to assess the effectiveness of specialist outreach clinics on access , quality , health outcomes , patient satisfaction , use of services , and costs . Search strategy : We search ed the Cochrane Effective Practice and Organisation of Care ( EPOC ) specialised register ( March 2002 ) , the Cochrane Controlled Trials Register ( CCTR ) ( Cochrane Library Issue 1 , 2002 ) , MEDLINE ( including HealthStar ) ( 1966 to May 2002 ) , EMBASE ( 1988 to March 2002 ) , CINAHL ( 1982 to March 2002 ) , the Primary - Secondary Care Data base previously maintained by the Centre for Primary Care Research in the Department of General Practice at the University of Manchester , a collection of studies from the UK collated in Specialist Outreach Clinics  in General Practice ( Rol and 1998 ) , and the reference lists of all retrieved articles . Selection criteria : R and omised trials , controlled before and after studies and interrupted time series analyses of  visiting specialist outreach clinics in primary care or rural hospital setting s , either providing simple consultations or as part of complex multifaceted interventions . The participants were patients , specialists , and primary care providers . The outcomes included objective measures of access , quality , health outcomes , satisfaction , service use , and cost . Data collection and analysis : Four review ers working in pairs independently extracted data and assessed study quality . Main results : 73 outreach interventions were identified covering many specialties , countries and setting s. Nine studies met the inclusion criteria . Most comparative studies came from urban non-disadvantaged population s in developed countries . Simple ‘ shifted out patients ’ styles of specialist outreach were shown to improve access , but there was no evidence of impact on health outcomes .  Specialist outreach as part of more complex multifaceted interventions involving collaboration with primary care , education or other services was associated with improved health outcomes , more efficient and guideline -consistent care , and less use of inpatient services . The additional costs of outreach may be balanced by improved health outcomes . Authors ' conclusions : This review supports the hypothesis that specialist outreach can improve access , outcomes and service use , especially when delivered as part of a multifaceted intervention . The benefits of simple outreach models in urban non-disadvantaged setting s seem small . There is a need for good comparative studies of outreach in rural and disadvantaged setting s where outreach may confer most benefit to access and health outcomes CONTEXT Few depressed older adults receive effective treatment in primary care setting s. OBJECTIVE To determine the effectiveness of the Improving Mood-Promoting Access to Collaborative Treatment ( IMPACT ) collaborative care management program for late-life depression .  DESIGN R and omized controlled trial with recruitment from July 1999 to August 2001 . SETTING Eighteen primary care clinics from 8 health care organizations in 5 states . PARTICIPANTS A total of 1801 patients aged 60 years or older with major depression ( 17 % ) , dysthymic disorder ( 30 % ) , or both ( 53 % ) . INTERVENTION Patients were r and omly assigned to the IMPACT intervention ( n = 906 ) or to usual care ( n = 895 ) . Intervention patients had access for up to 12 months to a depression care manager who was supervised by a psychiatrist and a primary care expert and who offered education , care management , and support of antidepressant management by the patient 's primary care physician or a brief psychotherapy for depression , Problem Solving Treatment in Primary Care . MAIN OUTCOME MEASURES Assessment s at baseline and at 3 , 6 , and 12 months for depression , depression treatments , satisfaction with care , functional impairment , and quality of life . RESULTS At 12 months , 45 % of intervention patients had a 50 % or greater reduction in depressive symptoms from baseline compared with 19 % of usual care participants ( odds ratio [ OR ] , 3.45 ; 95 % confidence interval [ CI ] , 2.71 - 4.38 ; P<.001 ) . Intervention patients also experienced greater rates of depression treatment ( OR , 2.98 ; 95 % CI , 2.34 - 3.79 ; P<.001 ) , more satisfaction with depression care ( OR , 3.38 ; 95 % CI , 2.66 - 4.30 ; P<.001 ) , lower depression severity ( range , 0 - 4 ; between-group difference , -0.4 ; 95 % CI , -0.46 to -0.33 ; P<.001 ) , less functional impairment ( range , 0 - 10 ; between-group difference , -0.91 ; 95 % CI , -1.19 to -0.64 ; P<.001 ) , and greater quality of life ( range , 0 - 10 ; between-group difference , 0.56 ; 95 % CI , 0.32 - 0.79 ; P<.001 ) than participants assigned to the usual care group . CONCLUSION The IMPACT collaborative care model appears to be feasible and significantly more effective than usual care for depression in a wide range of primary care practice A r and omized controlled trial was conducted to compare three forms of diabetes follow-up : ( 1 ) general practitioner care , ( 2 ) a system of care shared between the general practitioner ( GP ) and clinic and ( 3 ) conventional clinic care .  Two hundred and six diabetic patients without significant diabetes-related or other medical complications were r and omized to one of these follow-up systems .  Metabolic control and blood pressure improved significantly and equally in all three groups ( p < 0.05 ) . The shared care group performed as well as or better than either of the other two groups in all other outcome measures . In particular , final attendance rates were 72 % for shared care compared with only 35 % for GP care and 53 % for clinic care . Data collection rates for shared care were comparable with the clinic group for r and om blood glucose ( 88.9 % vs 95.1 % ) , weight ( 93.5 % vs 98.3 % ) , and blood pressure ( 94.8 % vs 92.7 % ) . Only in the case of glycosylated haemoglobin did shared care have poorer data collection ( 66.0 % vs 98.4 % ) . In all these parameters , except blood pressure , shared care out-performed the GP group . We conclude that with adequate support from and communication with hospital-based diabetes services , GPs are capable of providing care appropriate to the needs of uncomplicated diabetic patients A two year follow-up of two matched groups of subjects with chronic severe mental illness was performed in order to evaluate a new  psychiatric case management system .  One group ( n=59 ) received care through psychiatric case management , using an assertive community treatment model that directly involved general practitioners . The other group , matched for age , sex , diagnostic group and number of hospital admissions , received st and ard outpatient care . Comparing the two years before and after case management , the experimental group showed a dramatic fall in inpatient admission days while the control group admission days remained the same ( median difference in admission days across matched subject pairs = 64.5 , 95 % C.I. from 134.5 to 16 ) . The experimental group remained out of hospital longer before first readmission ( Kaplan-Meier survival analysis , P=0.002 ) . This type of case management programme can shorten or prevent admissions to psychiatric hospitals of patients with chronic mental illness , and increase their time before readmission AIMS To determine the effect of an integrated heart failure management programme , involving patient and family , primary and secondary care , on quality of life and death or hospital readmissions in patients with chronic heart failure . METHODS AND RESULTS This trial was a cluster r and omized , controlled trial of integrated primary / secondary care compared with usual care for patients with heart failure . The intervention involved clinical review at a hospital-based heart failure clinic early after discharge , individual and group education sessions , a personal diary to record medication and body weight , information booklets and regular clinical follow-up alternating between the general practitioner and heart failure clinic . Follow-up was for 12 months . One hundred and ninety-seven patients admitted to Auckl and Hospital with an episode of heart failure were enrolled in the study . There was no significant difference between the intervention and control groups for the combined end-point of death or hospital readmission . The physical dimension of quality of life showed a greater improvement in the intervention group from baseline to 12 months compared with the control group ( -11.1 vs -5.8 respectively , 2 P=0.015 ) . The main effect of the intervention was attributable to the prevention of multiple admissions ( 56 intervention group vs 95 control group , 2 P=0.015 ) and associated reduction in bed days . CONCLUSIONS This integrated management programme for patients with chronic heart failure  improved quality of life and reduced total hospital admissions and total bed days BACKGROUND Despite improvements in the accuracy of diagnosing depression and use of medications with fewer side effects , many patients treated with antidepressant medications by primary care physicians have persistent symptoms . METHODS A group of 228 patients recognized as depressed by their primary care physicians and given antidepressant medication who had either 4 or more persistent major depressive symptoms or a score of 1.5 or more on the Hopkins Symptom Checklist depression items at 6 to 8 weeks were r and omized to a collaborative care intervention ( n = 114 ) or usual care ( n = 114 ) by the primary care physician . Patients in the intervention group received enhanced education and increased frequency of visits by a psychiatrist working with the primary care physician to improve pharmacologic treatment . Follow-up assessment s were completed at 1 , 3 , and 6 months by a telephone survey team blinded to r and omization status . RESULTS Those in the intervention group had significantly greater adherence to adequate dosage of medication for 90 days or more and were more likely to rate the quality of care they received for depression as good to excellent compared with usual care controls . Intervention patients showed a significantly greater decrease compared with usual care controls in severity of depressive symptoms over time and were more likely to have fully recovered at 3 and 6 months . CONCLUSIONS A multifaceted program targeted to patients whose depressive symptoms persisted 6 to 8 weeks after initiation of antidepressant medication by their primary care physician was found to significantly improve adherence to antidepressants , satisfaction with care , and depressive outcomes compared with usual care Abstract Objective To determine the long term effectiveness of collaborative care management for depression in late life . Design Two arm , r and omised , clinical trial ; intervention one year and follow-up two years . Setting 18 primary care clinics in eight US healthcare organisations . Patients 1801 primary care patients aged 60 and older with major depression , dysthymia , or both . Intervention Patients were r and omly assigned to a 12 month collaborative care intervention ( IMPACT ) or usual care for depression . Teams including a depression care manager , primary care doctor , and psychiatrist offered education , behavioural activation , antidepressants , a brief , behaviour based psychotherapy ( problem solving treatment ) , and relapse prevention geared to each patient 's needs and preferences . Main outcome measures Interviewers , blinded to treatment assignment , conducted interviews in person at baseline and by telephone at each subsequent follow up . They measured depression ( SCL-20 ) , overall functional impairment and quality of life ( SF-12 ) , physical functioning ( PCS-12 ) , depression treatment , and satisfaction with care . Results IMPACT patients fared significantly ( P < 0.05 ) better than controls regarding continuation of antidepressant treatment , depressive symptoms , remission of depression , physical functioning , quality of 
    Output:
    
Overall there were no consistent improvements in physical or mental health outcomes , psychosocial outcomes , psychosocial measures including measures of disability and functioning , hospital admissions , default or participation rates , recording of risk factors and satisfaction with treatment .
However , there were clear improvements in prescribing in the studies that considered this outcome .
This review indicates that there is , at present , insufficient evidence to demonstrate significant benefits from shared care apart from improved prescribing .
This review indicates that there is no evidence to support the widespread introduction of shared care services at present .