Background
Methods
Results
Description of the studies
Geographic location of the studies
Programme classification | Studies | Description of intervention |
---|---|---|
Integrated Management of Childhood Illnesses (IMCI) | El Arifeen 2004 Armstrong Schellenberg 2004 | Integration based on treatment guidelines and training for management of childhood illnesses |
The Primary Care Research in Substance Abuse and Mental Health for the Elderly study (PRISM-E) | Bartels 2004 Krahn 2006 Oslin 2006 | Integrated delivery of mental health and/or substance abuse services for elderly veterans in a primary care setting |
Services for substance abuse and primary medical care | Weisner 2001 Willenbring 1999 | Substance abuse treatment integrated with medical treatment of substance abuse-related co-morbidities |
Mental health services in primary health care | Gater 1997 Watts 2007 Druss 2001 | Treatment services for depression, schizophrenia and other mental illness integrated into primary health care |
Types of interventions
Findings from the studies
Integrated Management of Childhood Illnesses
Type of outcome | Study | Measure | Outcome (IMCI vs. Control area) |
---|---|---|---|
Health outcomes
| Armstrong Schellenberg 2005 | Death rate per 1000 child years. | From 27.2 to 24.4 vs. from 27.0 to 28.2, (p = 0.28) |
Carer of child prescribed oral medication reports correctly how to give treatment. | 163/225 (72%) vs. 100/179 (56%), (p = 0.02) | ||
Quality of care
| Armstrong Schellenberg 2005 | Children checked for presence of cough, diarrhoea and fever. | 219/231 (95%) vs. 67/188 (36%), (p < 0.0001) |
Children correctly classified. | 139/219 (63%) vs. 66/176 (38%), (p < 0.0001) | ||
Correct prescription of oral antibiotics and/or oral anti-malarials. | 159/219 (73%) vs. 63/178 (35%), (p < 0.0001) | ||
El-Arifeen 2004 | Mean index of correct treatment and counselling. | From 8 to 54 vs. from 5 to 9, (p < 0.001) | |
Utilisation of services
| Armstrong Schellenberg 2005 | Change in appropriate care seeking behaviour. | From 211/512 (41%) to 203/531 (38%) vs. from 209/502 (42%) to 138/427 (30%), (p = 0.45) |
El-Arifeen 2004 | Ill children taken to a health facility or health worker. | From 10% to 19% vs. from 6% to 9% | |
Cost
| Adam 2005 | Annualised cost of care. | US$ 11.19 vs. US$ 16.09 |
Bryce 2005 | Cost per child visit managed correctly. | US$ 4.02 vs. US$ 25.70 |
Integrating substance abuse treatment for patients with substance abuse-related conditions
Type of outcome | Study | Measure | Outcome (Intervention vs. Control) |
---|---|---|---|
Health outcomes
| Druss 2001 | Change in physical component summary index. | +4.7% vs. -0.3%, (p < 0.001) |
Change in mental component summary index. | +2.4% vs. +2%, (p = 0.84) | ||
Krahn 2006 | Change in Centre for Epidemiological Studies Depression scale (CES-D) score. | Patients with all depression: -6.0 ± 12.0 vs. -7.8 ± 11.8, (p = 0.07) | |
Patients with major depression: -7.5 ± 13.1 vs. -10.2 ± 12.1, (p = 0.003) | |||
Change in Medical Component Score (MCS). | Patients with all depression: +4.8 ± 12.6 vs. +4.9 ± 12.9, (p = 0.88) | ||
Patients with major depression: +5.9 ± 12.6 vs. + 6.8 ± 12.8, (p = 0.32) | |||
Willenbring 1999 | Number of patients with 2-year survival. | 31/38 (81%) vs. 26/37 (70%), (p = 0.03) | |
Drug and alcohol use
| Oslin 2006 | Change in number of drinks per week. | -6.0 vs. -5.9 (p = 0.913) |
Change in number of binge episodes in the preceding three months. | -8.5 vs. -10.2 (p = 0.750) | ||
Weisner 2001 | Total abstinence and duration of abstinence. | Non-SAMC patients: 66% vs. 73%, (p = 0.23) | |
SAMC patients: 69% vs. 55%, (p = 0.006); period of abstinence 135 days vs. 122 days, (p = 0.05) | |||
Alcohol abstinence. | Non-SAMC patients: 73% vs. 78% (p = 0.41) | ||
SAMC patients: 80% vs. 65%, (p = 0.002) | |||
Other drug abstinence | Non-SAMC patients: 84% vs. 87%, (p = 0.50) | ||
Willenbring 1999 | Number of patients with alcohol abstinence after 2 years. | 28/38 (74%) vs. 17/36 (48%), (p = 0.02) | |
Patient satisfaction
| Druss 2001 | Satisfaction score on 47-item questionnaire. | Patients in integrated model were more satisfied with overall care received in 6 of 8 domains (access, attention to patient preferences, courtesy, coordination, continuity, and overall care) (p < 0.05 on all 6 domains) |
Gater 1997 | Score on Client Satisfaction Questionnaire (range 1-4; low score indicates higher satisfaction). | 1.86 vs. 2.23 | |
Quality of care
| Druss 2001 | Delivery of preventive measures outlined in clinical guidelines. | Patients in integrated model (n = 59) more likely than in control group (n = 61) to receive 15 of 17 measures, (p < 0.01) |
Gater 1997 | Number of clinical needs met; and unmet. | 2.62 vs. 1.60, (p < 0.001); 0.57 vs. 1.62 (p < 0.001) | |
Number of social needs met; and unmet. | 1.83 vs. 1.49, (p = NS); 0.86 vs. 1.64 (p < 0.05) | ||
Watts 2007 | Patients who screened positive for depression and received treatment in accordance with guidelines. | From 1.1% to 11.2% vs. from 3.0% to 0.7%, (p < 0.001) | |
Utilisation of services
| Bartels 2004 | Mean number of mental health and substance abuse visits. | 3.04 vs. 1.91 (p ≤ 0.001) |
Appointment attendance. | 71% vs. 48.8% (95% CI = 2.14 to 3.08) | ||
Druss 2001 | Patients who used a medical: Primary care service; Specialty service; Emergency department; Inpatient service. | 54/59 (91.5%) vs. 44/61 (72.1%), (p = 0.006); 41/59 (69.5%) vs. 41/61 (67.2%), (p = 0.17); 7/59 (11.9%) vs. 16/61 (26.2%), (p = 0.04); 5/59 (8.5%) vs. 11/61 (18%), (p = 0.12) | |
Patients who used a mental health: Outpatient service; Emergency department; Inpatient service. | 58/59 (98.3%) vs. 61/61 (100%), (p = 0.31); 21/59 (35.6%) vs. 25/61 (41%), (p = 0.31); 8/59 (13.6%) vs. 10/61 (16.4%), (p = 0.66) | ||
Willenbring 1999 | Mean number of IOT visits in 2 years. | 42.2 ± 29.1 vs. 17.4 ± 15.6, (p < 0.001) | |
Mean number of IOT visits in first and last 6 months of treatment. | From 14 to 9 vs. 4-6 in both periods | ||
Access to health care
| Watts 2007 | Patients who screened positive and were able to access mental health services. | 36.0% vs. 9%, (p < 0.001) |
Cost
| Druss 2001 | Mean cost per subject treated | US$ 13,010 vs. US$ 14,543 |
Gater 1997 | Overall per capita health service cost | £ 1,406 vs. £ 1,199 | |
Weisner 2001 | Average cost of all treatment per month | US$ 470.81 vs. US$ 427.95, (p = 0.14) |