Interventions to Improve Provider Diagnosis and Treatment of Mental Disorders in Primary Care: A Critical Review of the Literature

Kurt Kroenke · Anne L. Taylor-Vaisey · Allen J. Dietrich · Thomas E. Oxman

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Mental Health Treatment and Access Psychiatric care and mental health services Primary Care and Health Outcomes

Abstract

The authors conducted a critical review of the literature on interventions to improve provider recognition and management of mental disorders in primary care, searching the MEDLINE database for relevant articles published from 1966 through May 1998 and finding 48 usable controlled studies (27 randomized controlled trials and 21 quasi-experimental studies). Improved diagnosis of mental disorders was reported in 18 of 23 (78%) of the studies examining this outcome and improved treatment in 14 of 20 studies (70%); clinical improvement in psychiatric symptoms or functional status was documented in 4 of 11 and 4 of 8 (36% and 50%, respectively). Considerable study heterogeneity precluded subjecting the literature synthesis to a formal meta-analysis of pooled results; the authors were therefore unable to demonstrate an association between efficacy of an intervention and any specific variables. A variety of interventions and further research may be effective in improving the recognition and management of mental disorders in primary care.

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References

1994Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study 1994Utility of a New Procedure for Diagnosing Mental Disorders in Primary Care 1995Collaborative management to achieve treatment guidelines. Impact on depression in primary care 1995Best evidence synthesis: An intelligent alternative to meta-analysis 1996A Multifaceted Intervention to Improve Treatment of Depression in Primary Care 1992Long‐term effects of an educational program for general practitioners given by the Swedish Committee for the Prevention and Treatment of Depression 1991Recognition, Management, and Course of Anxiety and Depression in General Practice 1999Primary Care Physicians' Approach to Depressive Disorders: Effects of Physician Specialty and Practice Structure

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2006Improving Recognition of Adolescent Depression in Primary Care 2002Frequency and Scope of Mental Health Service Delivery to African Americans in Primary Care 2001Two-Year Effects of Quality Improvement Programs on Medication Management for Depression 2002Emotional disorders in primary care.

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