***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: This study reports the results of a r and omized 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 r and omization in psychiatric distress , functional disability , or utilization of health care ( ambulatory visits , radiographic and laboratory testing services , admissions to inpatient medical care ) OBJECTIVE To assess the impact of diverse  continuing medical education ( CME ) interventions on  physician performance and health care outcomes .  DATA SOURCES Using continuing medical education and related phrases , we performed regular search es of the indexed literature ( MEDLINE , Social Science Index , the National Technical Information Service , and Educational Research Information Clearinghouse ) from 1975 through 1991 . In addition , for these years , we used manual search es , key informants , and requests to authors to locate other indexed articles and the nonindexed literature of adult and continuing professional education . STUDY SELECTION From the result ing data base we selected studies that met the following criteria : r and omized controlled trials ; educational programs , activities , or other interventions ; studies that included 50 % or more physicians ; follow-up assessment s of at least 75 % of study subjects ; and objective assessment s of either physician performance or health care outcomes . DATA EXTRACTION Studies were review ed for data related to physician specialty and setting . Continuing medical education interventions were classified by their mode(s ) of activity as being predisposing , enabling , or facilitating . Using the statistical tests supplied by the original investigators , physician performance outcomes and patient outcomes were classified as positive , negative , or inconclusive . DATA SYNTHESIS We located 777 CME studies , of which 50 met all criteria . Thirty-two of these analyzed physician performance ; seven evaluated patient outcomes ; 11 examined both measures . The majority of the 43 studies of physician performance showed positive results in some important measures of re source utilization , counseling strategies , and preventive medicine . Of the 18 studies of health care outcomes , eight demonstrated positive changes in patients ' health care outcomes . CONCLUSION Broadly defined CME interventions using practice -enabling or reinforcing strategies consistently improve physician performance and , in some instances , health care outcomes AIMS To assess whether receipt of primary medical care can lead to improved outcomes for adults with addictions . DESIGN We studied a prospect i ve cohort of adults enrolled in a r and omized trial to improve linkage with primary medical care . METHODS Subjects at a residential detoxification unit with alcohol , heroin or cocaine as a substance of choice , and no primary medical care were enrolled .  Receipt of primary medical care was assessed over 2 years . Outcomes included ( 1 ) alcohol severity , ( 2 ) drug severity and ( 3 ) any substance use . FINDINGS For the 391 subjects , receipt of primary care ( > or = 2 visits ) was associated with a lower odds of drug use or alcohol intoxication ( adjusted odds ratio ( AOR ) 0.45 , 95 % confidence interval ( CI ) 0.29 - 0.69 , 2 d.f . chi(2)P = 0.002 ) . For 248 subjects with alcohol as a substance of choice , alcohol severity was lower in those who received primary care [ predicted mean Addiction Severity Index ( ASI ) alcohol scores for those reporting > or = 2 , 1 and 0 visits , respectively , 0.30 , 0.26 and 0.34 , P = 0.04 ] . For 300 subjects with heroin or cocaine as a substance of choice , drug severity was lower in those who received primary care ( predicted mean ASI drug scores for those reporting > or = 2 , 1 and 0 visits , respectively , 0.13 , 0.15 and 0.16 , P = 0.01 ) . CONCLUSIONS Receipt of primary medical care is associated with improved addiction severity . These results support efforts to link patients with addictions to primary medical care services 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 The object of the study was to evaluate outcomes of a r and omized clinical trial ( RCT ) of a pharmacist intervention for depressed patients in primary care ( PC ) . We report  antidepressant ( AD ) use and depression severity outcomes at 6-months . The RCT was conducted between 1998 and 2000 in 9 eastern Massachusetts PC practice s. We studied 533 patients with major depression and /or dysthymia as determined by a screening test done at the time of a routine PC office visit . The majority of participants had recurrent depressive episodes ( 63.5 % with > /=4 lifetime episodes ) , and 49.5 % were taking AD medications at enrollment . Consultation in person and by telephone was performed by a clinical pharmacist who assisted the primary care practitioner ( PCP ) and patient in medication choice , dose , and regimen , in accordance with AHCPR depression guidelines . Six-month AD use rates for intervention patients exceeded controls ( 57.5 % vs. 46.2 % , P = .03 ) . Furthermore , the intervention was effective in improving AD use rates for patients not on ADs at enrollment ( 32.3 % vs. 10.9 % , P = .001 ) . The pharmacist intervention proved equally effective in subgroups traditionally considered difficult to treat : those with chronic depression and dysthymia . Patients taking ADs had better modified Beck Depression Inventory ( mBDI ) outcomes than patients not taking ADs , ( -6.3 points change , vs. -2.8 , P = .01 ) but the outcome differences between intervention and control patients were not statistically significant ( 17.7 BDI points vs. 19.4 BDI points , P = .16 ) . Pharmacists significantly improved rates of AD use in PC patients , especially for those not on ADs at enrollment , but outcome differences were too small to be statistically significant . Difficult-to-treat subgroups may benefit from pharmacists ' care 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 BACKGROUND Significant underuse of evidence -based treatments for depression persists in primary care . We examined the effects of 2 primary care-based quality improvement ( QI ) programs on medication management for depression . METHODS A total of 1356 patients with depressive symptoms ( 60 % with depressive disorders and 40 % with subthreshold depression ) from 46 primary care practice s in 6 nonacademic managed care organizations were enrolled in a r and omized controlled trial of QI for depression . Clinics were r and omized to usual care or to 1 of 2 QI programs that involved training of local experts who worked with patients ' regular primary care providers ( physicians and nurse practitioners ) to improve care for depression . In the QI-medications program , depression nurse specialists provided patient education and assessment and followed up patients taking antidepressants for up to 12 months . In the QI-therapy program , depression nurse specialists provided patient education , assessment , and referral to study -trained psychotherapists . RESULTS Participants enrolled in both QI programs had significantly higher rates of antidepressant use than those in the usual care group during the initial 6 months of the study ( 52 % in the QI-medications group , 40 % in the QI-therapy group , and 33 % in the usual care group ) . Patients in the QI-medications group had higher rates of antidepressant use and a reduction in long-term use of minor tranquilizers for up to 2 years , compared with patients in the QI-therapy or usual care group . CONCLUSIONS Quality improvement programs for depression in which mental health specialists collaborate with primary care providers can substantially increase rates of antidepressant treatment . Active follow-up by a depression nurse specialist in the QI-medications program was associated with longer-term increases in antidepressant use than in the QI model without such follow-up 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 , 2.6 
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A systematic review and descriptive analysis is presented , with key conclusions and best practice s. RESULTS Successful collaboration requires preparation , time , and supportive structures , building on preexisting clinical relationships .
Collaborative practice is likely to be most developed when clinicians are colocated and most effective when the location is familiar and nonstigmatizing for patients .
Degree of collaboration does not appear to predict clinical outcome .
Enhanced collaboration paired with treatment guidelines or protocol s offers important benefits over either intervention alone in major depression .
Systematic follow-up was a powerful predictor of positive outcome in collaborative care for depression .
A clear relation between collaborative efforts to increase medication adherence and clinical outcomes was not evident .
Collaboration alone has not been shown to produce skill transfer in PCP knowledge or behaviours in the treatment of depression .
Collaborative interventions that are part of a research protocol may be difficult to sustain long-term without ongoing funding .
Consumer choice about treatment modality may be important in treatment engagement in collaborative care ( for example , having the option to choose psychotherapy vs medication ) .