***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 OBJECTIVE The purpose of the study was to investigate the effect of comorbid depression on glycemic control and on response to a telemedicine case management intervention for elderly , ethnically diverse diabetic patients . RESEARCH DESIGN AND METHODS Medicare beneficiaries in underserved areas were participants ( n = 1,665 ) in the Informatics for Diabetes Education and Telemedicine ( IDEATel ) project and r and omized to a telemedicine case management intervention or usual care .  The data analyzed include baseline demographics ( age , sex , race/ethnicity , marital status , insulin use , years of education , years of diabetes , and pack-years smoked ) and measures of glycemic control ( HbA(1c ) [ A1C ] ) , comorbidity , diabetes symptom severity , functional disability and depression , and 1-year ( n = 1,578 ) A1C . The association between depression and glycemic control was analyzed cross-sectionally and prospect ively . RESULTS At baseline , there was a significant correlation between depression and A1C and a trend for depression to predict A1C when other factors were controlled . However , in prospect i ve analyses , depression did not predict change in A1C , either in the control or intervention group . CONCLUSIONS In this large sample of elderly diabetic patients , a weak relationship between depression and A1C was found , but depression did not prospect ively predict change in glycemic control . Thus , there is no evidence that depression should be used to exclude patients from interventions . Also , we should evaluate the impact of depression on outcomes other than glycemic control We prospect ively studied 354 patients with hepatitis C virus ( HCV ) infection who were referred to a hepatology specialty clinic to find the reasons for non-treatment of HCV .  The median age was 48 years ( range 27 - 77 years ) , 98.5 % were male and 71 % were white . Seventy per cent of the patients were not treated . The most common reasons for non-treatment were non-adherence to follow-up visit ( 24 % ) , normal liver enzymes ( 14 % ) , concurrent medical problems ( 11 % ) , alcohol and drug use ( 9 % ) , psychiatric problems ( 7 % ) , advanced liver disease ( 7 % ) , referral for transplant evaluation ( 6.4 % ) and patient refusal , transfer of care to another facility and non-detectable HCV RNA levels ( 5 % each ) . The reason was not recorded for 5 % of the patients and was treatment deferred in 2.4 % while waiting for pegylated interferon approval . Non-treatment was more likely in patients with less than 12 years of education and a history of incarceration . Patients who were lost to follow-up and refused treatment were more likely to have current alcohol and drug use and a history of incarceration Objective : The objective of this study was to determine if receipt of revascularization  was similar among commercially insured adults with mental disorders compared with people without mental disorders . Methods : This was a retrospective analysis of a 100 % sample of Blue Cross/Blue Shield of Iowa administrative cl aims data , 1996 to 2001 . Logistic regression was used to calculate unadjusted and adjusted odds ratios ( OR ) for receipt of angioplasty ( PTCA ) and bypass graft surgery ( CABG ) within 30 days of discharge . Results : A total of 3368 adults , aged 18 to 64 years , were hospitalized for myocardial infa rct ion ( MI ) and 40 % ( n = 1342 ) had a mental disorder . Subjects with mental disorders were more likely to be younger , female , urban residents , and to have increased cardiovascular and medical comorbidity . They were similarly likely as subjects without mental disorders to have received PTCA ( OR , 1.10 ; 95 % confidence interval [ CI ] , 0.95–1.29 ) and CABG ( OR , 0.89 ; 95 % CI , 0.71–1.11 ) in analyses adjusted for demographic and clinical characteristics . Revascularization rates did not differ by mental disorder type , with few exceptions . Conclusions : Receipt of revascularization  was similar for patients with and without mental disorders . Our results may differ from previous findings as a result of the younger population studied and increased comorbidity in people with mental disorders , which may have result ed in a contraindication for surgical intervention . Conversely , the increased burden of comorbidity could suggest that these patients should have received PTCA at higher rates because of the better prognosis associated with revascularization as compared with medical management . Prospect i ve analyses with review of clinical data and behavioral risk factors are necessary to determine why some patients with mental illness may be less likely to receive cardiac interventions . MI = myocardial infa rct ion ; CVD = cardiovascular disease ; MHD = mental health disorders ; PTCA = percutaneous transluminal coronary angioplasty ; CABG = coronary artery bypass graft surgery ; CPT = Common Procedural Terminology ; ICD = International Classification of Diseases ; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition ; OR = odds ratio ; COPD = chronic obstructive pulmonary disease ; CI = confidence interval Background / Objective .Somatic health care utilization was studied among individuals with serious mental illness who were receiving community-based psychiatric services . Research Design .Cross-sectional study . SubjectsA total of 200 out patients , 100 with schizophrenia and 100 with affective disorder , were recruited from r and omly selected sample s receiving care at two psychiatric centers . Measures . Patients were interviewed using questions from national health surveys . Multiple logistic regression analyses were used to compare responses from each sample to those of matched subsets of individuals from the general population . Results .The psychiatric sample s were more likely to report receiving some medical care services in the past year than were individuals in the general population including having visited a general medical doctor ( Odds ratio , schizophrenia sample = 2.04 ; Odds ratio , affective disorder sample = 2.37 ) and having a complete physical examination ( Odds ratio , schizophrenia sample = 2.69 ; Odds ratio , affective disorder sample = 1.74 ) . However , our sample s were less likely to receive routine dental care  ( Odds ratio , schizophrenia sample = 0.46 ; Odds ratio , affective disorder sample = 0.60 ) . Perceived barriers to receiving medical care were reported significantly more often by the patient groups than the comparison groups ( Odds ratios > 3 ) . Conclusions . General health services are widely utilized by individuals with serious mental illness who are in outpatient psychiatric care . Dental services remain underutilized , however , and there is a high rate of perceived barriers to receiving medical care in this population BACKGROUND A significant percentage of patients with major depressive disorder ( MDD ) suffer from concurrent general medical conditions ( GMCs ) . OBJECTIVE The objective of this preliminary report was to describe the rates of co-occurring significant GMCs and the clinical correlates and symptom features associated with the presence of GMCs . DESIGN Baseline cross-sectional case-control study of patients enrolling in a prospect i ve r and omized multistage treatment study of MDD . SETTING Fourteen regional U.S. centers representing 19 primary care and 22 psychiatric practice s. PATIENTS One thous and five hundred out patients with DSM-IV nonpsychotic MDD . MEASUREMENTS Sociodemographic status , medical illness ratings , psychiatric status , quality of life and DSM-IV depression symptom ratings . RESULTS The prevalence of significant medical comorbidity in this population was 52.8 % ( 95 % CI 50.3 - 55.3 % ) . Concurrent significant medical comorbidity was associated with older age , lower income , unemployment , limited education , longer duration of index depressive episode and absence of self-reported family history of depression . Somatic symptoms common in MDD were endorsed at a higher rate in those with GMCs . Those without a GMC had higher rates of endorsement of impaired mood reactivity , distinct mood quality and interpersonal sensitivity . CONCLUSIONS Concurrent GMCs are common among out patients with MDD in both primary care and specialty setting s. Concurrent GMCs appear to influence the severity and symptom patterns in MDD and describe a vulnerable population with sociodemographic challenges to effective assessment and treatment OBJECTIVE This study identified factors associated with use of the emergency department for medical reasons among individuals with serious mental illness . METHODS A total of 200 r and omly selected out patients who were receiving community-based psychiatric care  were recruited for the study and interviewed with items from the National Health Interview Survey and other national health surveys . RESULTS Emergency department use ( 37 percent of the sample ) was negatively associated with older age and positively associated with the number of co-occurring medical conditions , smoking , recent injury , and recent change in health care provider . CONCLUSIONS The relatively high rate of emergency department use may be suggestive of inappropriate use or may reflect perceived barriers to care . Future work should identify specific reasons for seeking care in the emergency department and develop interventions to optimize appropriate emergency department use We determined whether patients with serious mental illness ( SMI ) were less likely than non-SMI to self-report having a medical condition that was recorded in their medical record . We included all patients from the VA National Psychosis Registry diagnosed with SMI and a r and om sample of non-SMI patients in fiscal year 1999 who completed the Large Health Survey of Veteran Enrollees ( N = 35,837 ) . Among patients with diagnoses for any of 11 conditions recorded in administrative data , we evaluated whether patients reported having that same condition in the survey , using multivariable logistic regression and generalized estimating equations . Among patients diagnosed with a given condition , those with SMI were less likely to report being told by providers that they had seven of the 11 conditions examined : heart disease ( OR = 0.68 , p < 0.001 ) , arthritis ( OR = 0.79 , p < 0.001 ) , cancer ( OR = 0.69 , p < 0.001 ) , diabetes ( OR = 0.79 , p < 0.001 ) , back pain ( OR = 0.81 , p < 0.001 ) , congestive heart failure ( OR = 0.71 , p < 0.001 ) , and hypertension ( OR = 0.77 , p < 0.001 ) . Patients with SMI were less aware of co-occurring medical conditions Objective : To assess the relationship between psychiatric disorders  and lack of regular medical care in individuals with chronic medical 
    Output:
    
Despite similar or more frequent medical contacts , there are often disparities in the physical healthcare delivered to those with psychiatric illness although the magnitude of this effect varies considerably