Improving general medical care for persons with mental and addictive disorders: systematic review

Gen Hosp Psychiatry. 2006 Mar-Apr;28(2):145-53. doi: 10.1016/j.genhosppsych.2005.10.006.


Objective: To conduct a systematic review of studies of interventions designed to improve general medical care in persons with mental and addictive disorders.

Methods: Following Cochrane Collaboration guidelines, a comprehensive search through October 2005 was conducted in multiple bibliometric indexes using search terms related to primary medical care and mental health/addictive disorders. Two assessors independently extracted information on linkage, quality, outcomes and costs of care.

Results: Six randomized trials met the preestablished search criteria. The interventions spanned a continuum of approaches for improving treatment, ranging from on-site medical consultation, through team-based approaches, to models involving facilitated referrals to primary care. The studies demonstrated a substantial positive impact on linkage to and quality of medical care; there was evidence of health improvement and improved abstinence rates in patients with greater medical comorbidity. The three studies that assessed expenditures found the programs to be cost-neutral from a health-plan perspective.

Conclusion: A small but growing body of research suggests that a range of models may hold potential for improving these patients' health and health care, at a relatively modest cost. Future work should continue to develop and test approaches to this problem that can be tailored to local system needs and capacities.

Publication types

  • Research Support, N.I.H., Extramural
  • Review
  • Systematic Review

MeSH terms

  • Behavior, Addictive*
  • Family Practice*
  • Humans
  • Mental Disorders*
  • Patients / psychology
  • Quality of Health Care*
  • Randomized Controlled Trials as Topic
  • Total Quality Management
  • United States