Cited by 417Mental Health Treatment and AccessPsychiatric care and mental health servicesSubstance Abuse Treatment and Outcomes

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Improving Access to Geriatric Mental Health Services: A Randomized Trial Comparing Treatment Engagement With Integrated Versus Enhanced Referral Care for Depression, Anxiety, and At-Risk Alcohol Use

Bartels, Stephen J., Coakley, Eugenie H., Zubritsky, Cynthia, Ware, James H., Miles, Keith M., Areán, Patricia A., Chen, Hongtu, Oslin, David W., Llorente, Maria D., Costantino, Giuseppe, Quijano, Louise, McIntyre, Jack S., Linkins, Karen W., Oxman, Thomas E., Maxwell, James, Levkoff, Sue E., PRISM-E Investigators·2004·American Journal of Psychiatry

DOI 10.1176/appi.ajp.161.8.1455

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Abstract

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 randomized 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 randomly 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.

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Authors: Bartels, S. J., Coakley, E. H., Zubritsky, C., Ware, J. H., Miles, K. M., Areán, P. A., Chen, H., Oslin, D. W., Llorente, M. D., Costantino, G., Quijano, L., McIntyre, J. S., Linkins, K. W., Oxman, T. E., Maxwell, J., Levkoff, S. E., & PRISM-E Investigators
Affiliations: Dartmouth College (US)
ORCID: Bartels, Stephen J.
Areán, Patricia A.
Chen, Hongtu
Oslin, David W.
Maxwell, James
Levkoff, Sue E.
Venue: American Journal of Psychiatry
Publisher: American Psychiatric Association Publishing
Published: 2004-08-01
Volume: 161
Issue: 8
Pages: 1455-1462
ISSN: 0002-953X (ISSN-L)
1535-7228
DOI: 10.1176/appi.ajp.161.8.1455
OpenAlex: W2157253072
Cited by: 417
References: 23
Citations by year: 2026: 5 · 2025: 5 · 2024: 15 · 2023: 6 · 2022: 14 · 2021: 13 · 2020: 16 · 2019: 13 · 2018: 18 · 2017: 16 · 2016: 19 · 2015: 35 · 2014: 28 · 2013: 23 · 2012: 23
FWCI: 29.67
Type: journal article
Language: en
Open access: closed
Locations: American Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
Funders: U.S. Department of Health and Human Services
Australian Government
Centers for Medicare and Medicaid Services
Center for Substance Abuse Treatment
Center for Mental Health Services
Center for Substance Abuse Prevention
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Keywords: integrated care, geriatric mental health services, treatment engagement, older adults, depression, anxiety, at-risk alcohol use, dual diagnosis, substance abuse, primary care, access to mental health care
MeSH terms: Age Factors, Aged, Alcohol Drinking, Anxiety Disorders, Community Mental Health Centers, Depressive Disorder, Major, Major Depressive Disorder, Depressive Disorder, Female, Health Services Accessibility, Health Services for the Aged, Health Services Misuse, Humans, Male, Primary Health Care, Referral and Consultation, Severity of Illness Index, Substance Abuse Treatment Centers, Treatment Outcome, Delivery of Health Care, Integrated

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Improving Access to Geriatric Mental Health Services: A Randomized Trial Comparing Treatment Engagement With Integrated Versus Enhanced Referral Care for Depression, Anxiety, and At-Risk Alcohol Use

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