***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: Objective : To describe the design of the Primary Care Research in Substance Abuse and Mental Health for Elderly ( PRISM-E ) study and baseline characteristics of the r and omized primary care patients with mental health problems and at-risk alcohol use . Method : Adults aged 65 and older were screened at primary care clinics from 10 study sites throughout the United States . Those diagnosed for depression , anxiety , and /or at-risk alcohol consumption were r and omized to either integrated or enhanced referral care . Results : Of the 23,828 participants , 14 % had a positive assessment for depressive and /or anxiety disorders  , and 6 % had at-risk alcohol consumption diagnoses . Among patients with mental health diagnoses , there was a higher preponderance of younger ages , women , and ethnic minorities . Among patients with at-risk drinking , there was a higher preponderance of younger ages , Whites , and men . Discussion : These findings indicate the need for screening in primary care and for engaging older adults in treatment OBJECTIVES To determine the effect of collaborative care management for depression on physical functioning  in older adults . DESIGN Multisite r and omized clinical trial . SETTING Eighteen primary care clinics from eight healthcare organizations . PARTICIPANTS One thous and eight hundred one patients aged 60 and older with major depressive disorder . INTERVENTION Patients were r and omized to the Improving Mood :  Promoting Access to Collaborative Treatment ( IMPACT ) intervention ( n=906 ) or to a  control group receiving usual care ( n=895 ) . Control patients had access to all health services available as part of usual care . Intervention patients had access for 12 months to a depression clinical specialist who coordinated depression care with their primary care physician . MEASUREMENTS The 12-item short form Physical Component Summary ( PCS ) score ( range 0 - 100 ) and instrumental activities of daily living ( IADLs ) ( range 0 - 7 ) . RESULTS The mean patient age was 71.2 , 65 % were women , and 77 % were white . At baseline , the mean PCS was 40.2 , and the mean number of IADL dependencies was 0.7 ; 45 % of participants rated their health as fair or poor . Intervention patients experienced significantly better physical functioning at 1 year than usual-care patients as measured using between-group differences on the PCS of 1.71 ( 95 % confidence interval (CI)=0.96 - 2.46 ) and IADLs of -0.15 ( 95 % CI=-0.29 to -0.01 ) . Intervention patients were also less likely to rate their health as fair or poor ( 37.3 % vs 52.4 % , P<.001 ) . Combining both study groups , patients whose depression improved were more likely to experience improvement in physical functioning . CONCLUSION The IMPACT collaborative care model for late-life depression improves physical function more than usual care Background Evidence -based practice s design ed for large urban clinics are not necessarily portable into smaller isolated clinics . Implementing practice -based collaborative care for depression in smaller primary care clinics presents unique challenges because it is often not feasible to employ on-site psychiatrists . Objective The purpose of the Telemedicine Enhanced Antidepressant Management ( TEAM ) study was to evaluate a telemedicine-based collaborative care model adapted for small clinics without on-site psychiatrists . Design Matched sites were r and omized to the intervention or usual care . Participants Small VA Community-based outpatient clinics with no on-site psychiatrists , but access to telepsychiatrists .  In 2003–2004 , 395 primary care patients with PHQ9 depression severity scores ≥12 were enrolled , and followed for 12 months . Patients with serious mental illness and current substance dependence were excluded .  Measures Medication adherence , treatment response , remission , health status , health-related quality of life , and treatment satisfaction . Results The sample comprised mostly elderly , white , males with substantial physical and behavioral health comorbidity . At baseline , subjects had moderate depression severity (  Hopkins Symptom Checklist , SCL-20 = 1.8 ) , 3.7 prior depression episodes , and 67 % had received prior depression treatment . Multivariate analyses indicated that intervention patients were more likely to be adherent at both 6 ( odds ratio [ OR ] = 2.1 , p = .04 ) and 12 months ( OR = 2.7 , p = .01 ) . Intervention patients were more likely to respond by 6 months ( OR = 2.0 , p = .02 ) , and remit by 12 months ( OR = 2.4 , p = .02 ) . Intervention patients reported larger gains in mental health status and health-related quality of life , and reported higher satisfaction . Conclusions Collaborative care can be successfully adapted for primary care clinics without on-site psychiatrists using telemedicine technologies 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 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 Background Whether the acute outcomes of major depressive disorder ( MDD ) treated in primary ( PC ) or specialty care ( SC ) setting s are different is unknown . Objective To compare the treatment and outcomes for depressed out patients treated in primary versus specialty setting s with citalopram in the Sequenced Treatment Alternatives to Relieve Depression ( STAR*D ) study ( www.star-d.org ) , a broadly inclusive effectiveness trial . Design Open clinical trial with citalopram for up to 14 weeks at 18 primary and 23 specialty sites . Participants received measurement-based care with 5 recommended treatment visits , manualized pharmacotherapy , ongoing support and guidance by a clinical research coordinator , the use of structured evaluation of depressive symptoms and side effects at each visit , and a central ized treatment monitoring and feedback system . Participants A total of 2,876 previously established out patients in primary ( n = 1091 ) or specialty ( n = 1785 ) with nonpsychotic depression who had at least 1 post-baseline measure . Measurements and Main Results Remission ( Hamilton Depression Rating Scale for Depression [ Hamilton ] or 16-item Quick Inventory of Depressive Symptomatology-Self-Rated [ QIDS-SR16 ] ) ; response ( QIDS-SR16 ) ; time to first remission ( QIDS-SR16 ) . Remission rates by Hamilton ( 26.6 % PC vs 28.0 % SC , p = .40 ) and by QIDS-SR16 ( 32.5 % PC vs 33.1 % SC , p = .78 ) and response rates by QIDS-SR16 ( 45.7 % PC vs 47.6 % SC , p = .33 ) were not different . For those who reached remission or response at exit , the time to remission ( 6.2 weeks PC vs 6.9 weeks SC , p = .12 ) and to response ( 5.5 weeks PC vs 5.4 weeks SC , p = .97 ) did not differ by setting . Conclusions Identical remission and response rates can be achieved in primary and specialty setting s when identical care is provided It is difficult to evaluate the promise of primary care quality -improvement interventions for de 
    Output:
    
Although most trials showed positive effects , the degree of integration was not significantly related to depression outcomes .