***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: CONTEXT The prevalence of medical disorders is high among substance abuse patients , yet medical services are seldom provided in coordination with substance abuse treatment . OBJECTIVE To examine differences in treatment outcomes and costs between integrated and independent models of medical and substance abuse care as well as the effect of integrated care in a subgroup of patients with substance abuse-related medical conditions ( SAMCs ) . DESIGN R and omized controlled trial conducted between April 1997 and December 1998 . SETTING AND PATIENTS Adult men and women ( n = 592 ) who were admitted to a large health maintenance organization chemical dependency program in Sacramento , Calif. INTERVENTIONS Patients were r and omly assigned to receive treatment through an integrated model , in which primary health care was included within the addiction treatment program ( n = 285 ) , or an independent treatment-as-usual model , in which primary care and substance abuse treatment were provided separately ( n = 307 ) . Both programs were group based and lasted 8 weeks , with 10 months of aftercare available . MAIN OUTCOME MEASURES Abstinence outcomes , treatment utilization , and costs 6 months after r and omization . RESULTS Both groups showed improvement on all drug and alcohol measures . Overall , there were no differences in total abstinence rates between the integrated care and independent care groups ( 68 % vs 63 % , P = .18 ) . For patients without SAMCs , there were also no differences in abstinence rates ( integrated care , 66 % vs independent care , 73 % ; P = .23 ) and there was a slight but nonsignificant trend of higher costs for the integrated care group ( $ 367.96 vs $ 324.09 , P = .19 ) . However , patients with SAMCs ( n = 341 ) were more likely to be abstinent in the integrated care group than the independent care group ( 69 % vs 55 % , P = .006 ; odds ratio [ OR ] , 1.90 ; 95 % confidence interval [ CI ] , 1.22 - 2.97 ) . This was true for both those with medical ( OR , 3.38 ; 95 % CI , 1.68 - 6.80 ) and psychiatric ( OR , 2.10 ; 95 % CI , 1.04 - 4.25 ) SAMCs . Patients with SAMCs had a slight but nonsignificant trend of higher costs in the integrated care group ( $ 470.81 vs $ 427.95 , P = .14 ) . The incremental cost-effectiveness ratio per additional abstinent patient with an SAMC in the integrated care group was $ 1581 . CONCLUSIONS Individuals with SAMCs benefit from integrated medical and substance abuse treatment , and such an approach can be cost-effective . These findings are relevant given the high prevalence and cost of medical conditions among substance abuse patients , new developments in medications for addiction , and recent legislation on parity of substance abuse with other medical benefits BACKGROUND The Integrated Management of Childhood Illness ( IMCI ) strategy is design ed to address major causes of child mortality at the levels of community , health facility , and health system . We assessed the effectiveness of facility-based IMCI in rural Tanzania . METHODS We compared two districts with facility-based IMCI and two neighbouring comparison districts without IMCI , from 1997 to 2002 , in a non-r and omised study . We assessed quality of  case-management for children 's illness , drug and vaccine availability , and supervision involving case-management , through a health-facility survey in 2000 . Household surveys were used to assess child-health indicators in 1999 and 2002 . Survival of children was tracked through demographic surveillance over a predefined 2-year period from mid 2000 . Further information on context ual factors was gathered through interviews and record review . The economic cost of health care for children in IMCI and comparison districts was estimated through interviews and record review at national , district , facility , and household levels . FINDINGS During the IMCI phase-in period , mortality rates in children under 5 years old were almost identical in IMCI and comparison districts . Over the next 2 years , the mortality rate was 13 % lower in IMCI than in comparison districts ( 95 % CI -7 to 30 or 5 to 21 , depending on how adjustment is made for district-level clustering ) , with a rate difference of 3.8 fewer deaths per 1000 child-years . Context ual factors , such as use of mosquito nets , all favoured the comparison districts . Costs of children 's health care with IMCI were similar to or lower than those for case-management without IMCI . INTERPRETATION Our findings indicate that facility-based IMCI is good value for money , and support widespread implementation in the context of health-sector reform , basket funding , good facility access , and high utilisation of health facilities OBJECTIVE The authors sought to determine whether integrated mental health services or enhanced referral to specialty mental health clinics results in greater engagement in mental health/substance abuse services by older primary care patients . METHOD This multisite r and omized trial included 10 sites consisting of primary care and specialty mental health/substance abuse clinics . Primary care patients 65 years old or older ( N=24,930 ) were screened . The final study group consisted of 2,022 patients ( mean age=73.5 years ; 26 % female ; 48 % ethnic minority ) with depression ( N=1,390 ) , anxiety ( N=70 ) , at-risk alcohol use ( N=414 ) , or dual diagnosis ( N=148 ) who were r and omly assigned to integrated care ( mental health and substance abuse providers co-located in primary care ; N=999 ) or enhanced referral to specialty mental health/substance abuse clinics  ( i.e. , facilitated scheduling , transportation , payment ; N=1,023 ) . RESULTS Seventy-one percent of patients engaged in treatment in the integrated model compared with 49 % in the enhanced referral model . Integrated care was associated with more mental health and substance abuse visits per patient ( mean=3.04 ) relative to enhanced referral ( mean=1.91 ) . Overall , greater engagement was predicted by integrated care and higher mental distress . For depression , greater engagement was predicted by integrated care and more severe depression . For at-risk alcohol users , greater engagement was predicted by integrated care and more severe problem drinking . For all conditions , greater engagement was associated with closer proximity of mental health/substance abuse services to primary care . CONCLUSIONS Older primary care patients are more likely to accept collaborative mental health treatment within primary care than in mental health/substance abuse clinics . These results suggest that integrated service arrangements improve access to mental health and substance abuse services for older adults who underuse these services BACKGROUND This r and omized trial evaluated an integrated model of primary medical care for a cohort of patients with serious mental disorders . METHODS A total of 120 individuals enrolled in a Veterans Affairs ( VA ) mental health clinic were r and omized to receive primary medical care through an integrated care initiative located in the mental health clinic ( n = 59 ) or through the VA general medicine clinic ( n = 61 ) . Veterans who obtained care in the  integrated care clinic received on-site primary care and case management that emphasized preventive medical care , patient education , and close collaboration with mental health providers to improve access to and continuity of care . Analyses compared health process ( use of medical services , quality of care , and satisfaction ) and outcomes ( health and mental health status and costs ) between the groups in the year after r and omization . RESULTS Patients treated in the integrated care clinic were significantly more likely to have made a primary care visit and had a greater mean number of primary care visits than those in the usual care group . They were more likely to have received 15 of the 17 preventive measures outlined in clinical practice guidelines . Patients assigned to the integrated care clinic had a significantly greater improvement in health as measured by the physical component summary score of the 36-Item Short-Form Health Survey than patients assigned to the general medicine clinic ( 4.7 points vs -0.3 points , P<.001 ) . There were no significant differences between the 2 groups in any of the measures of mental health symptoms or in total health care costs . CONCLUSION On-site , integrated primary care was associated with improved quality and outcomes of medical care OBJECTIVE This study was part of the Primary Care Research in Substance Abuse and Mental Health for the Elderly study ( PRISM-E ) and determined the relative effectiveness of two different models of care for reducing at-risk alcohol use among primary care patients aged 65 and older . METHODS This multisite study was a r and omized clinical trial comparing integrated care with enhanced specialty referral for older primary care patients screened and identified to have at-risk drinking . RESULTS Before the study , the 560 participants consumed a mean of 17.9 drinks per week and had a mean of 21.1 binge episodes in the prior three months . At six months , both treatment groups reported lower levels of average weekly drinking ( p<.001 ) and binge drinking ( p<.001 ) , despite low levels of treatment engagement . However , the declines did not differ significantly between treatment groups . CONCLUSIONS These results suggest that older persons with at-risk drinking can substantially modify their drinking over time . Although no evidence suggested that the model of care was important in achieving this result , the magnitude of reduction in alcohol use was comparable with other intervention studies BACKGROUND Medically ill alcoholics often do not respond to conventional alcoholism treatment or decline physician referrals . Integrated outpatient treatment ( IOT ) , a new treatment specifically design ed for this population , combines comprehensive medical care with alcoholism interventions . OBJECTIVE To compare the efficacy of IOT with that of st and ard treatment approaches . METHODS One hundred five male veterans with severe medical complications caused by alcoholism and recent drinking were r and omly assigned to receive IOT or referral to st and ard alcoholism and medical treatment  and were evaluated over 2 years . Integrated outpatient treatment patients received medical care and alcoholism interventions once or twice monthly . Patients in the control group were referred for alcoholism treatment , but few accepted . However , patients in the control group did engage in outpatient medical care . RESULTS At baseline , the mean + /- SD age of the control group was 57.2 + 10.0 years , compared with 52.8 + /- 11.5 years in the IOT group ( P= .04 ) . The groups were well matched in other respects . The mean + /- SD number of visits over 2 years for the IOT patients was 42.2 + /- 29.1 , compared with 17.4 + /- 15.6 for the control patients ( P<.001 ) ; the frequency of hospital use was similar in both groups . After 2 years , 28 ( 74 % ) of 38 surviving IOT patients and 17 ( 47 % ) of 36 control patients were abstinent ( P=.02 ) . Nearly twice as many control patients ( 30 % [ n = 16 ] ) as IOT patients ( 18 % [ n= 9 ] ) died , but the results of Cox survival analysis were not significant . There were no differences in symptoms of alcohol dependence , quality of life , or life problems . The incremental cost of IOT was approximately $ 1100 per patient per year . CONCLUSIONS St and ard medical care alone was surprisingly effective in inducing abstinence in surviving medically ill alcoholics . Integrated outpatient treatment significantly increased both engagement and abstinence for a modest annual cost . Further refinement and testing of IOT is indicated 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 r and omly 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 r and omly assigned to the enhanced specialty referral group OBJECTIVES To assess the effect of Integrated Management of Childhood Illness ( IMCI ) relative to routine care on the quality and efficiency of providing care for sick children in first-level health facilities in Tanzania , and to disseminate the results for use in health sector decision-making . DESIGN Non-r and omized controlled trial to compare child health care quality and economic costs in two intervention ( > 90 % of health care workers trained in IMCI ) and two comparison districts in rural Tanzania . PARTICIPANTS For quality measures , all sick children presenting for care at r and om sample s of first-level health facilities ; for costs , all national , district , facility and household costs associated with child health care , taking a societal perspective . RESULTS IMCI training is associated with significantly better child health care in facilities at no additional cost to districts . The cost per child visit managed correctly was lower in IMCI than in routine care setting s : $ 4.02 versus $ 25.70 , respectively , in 1999 US dollars and after st and ardization for variations in population size . CONCLUSION IMCI improved the quality and efficiency of child health care relative to routine 
    Output:
    
Integrated service delivery result ed in better clinical outcomes and greater reduction of substance abuse in specific sub-groups of patients , with no significant difference found overall .
Quality of care , patient satisfaction , and treatment engagement were higher in integrated delivery models .
Conclusions Targeted priority population health interventions we identified led to improved health outcomes , quality of care , patient satisfaction and access to care .
Limited evidence with inconsistent findings across varied interventions in different setting s means no general conclusions can be drawn on the benefits or disadvantages of integrated service delivery