Research Shows

Research Shows; Integrated Behavioral Health Treatment is More Effective in Improving the Health and Care of Patients

Article: Integrated Medical Care for Patients with Serious Psychiatric Illness Authors: B. Druss, R. Rohrbaugh, C. Levinson, and R. Rosenheck

120 individuals in a Veterans Affairs (VA) mental health clinic were randomly assigned to receive primary medical care through an integrated care program in the mental health clinic or through the VA general medicine clinic.

The study tested the hypothesis that “integrated care can increase access to primary care services, raise quality of preventative care, and improve health-related quality of life” (862)

The integrated care clinic provided the benefits of:

  • On-site treatment ;
  • A shared patient chart
  • One clinician who acted as liaison between treatment teams and with the patient
  • Enhanced communication between providers – weekly team meetings, e-mails, telephone communication, and face-to-face discussions
  • A common treatment goal

Major findings:

  • Integrated behavioral health and medical care all at one location promoted greater access to primary and preventative care
  • Patients in the integrated care program showed significantly greater improvement in health status than patients in the usual care program
  • No significant difference between the two groups in total health care costs ;
  • Integrated treatment can improve the care and health of patients with serious mental disorders

Article: A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness

Authors: L. Petersen, P. Jepppesen, A. Thorup, et al.

547 individuals with first episode of schizophrenia spectrum disorder were randomly assigned to integrated treatment and standard treatment at the Copenhagen Hospital Corporation and at Psychiatric Hospital Aarhus in Denmark.

The study’s null hypothesis was “that there would be no differences between integrated treatment and standard treatment with regard to psychotic and negative symptoms, treatment adherence, admissions, use of bed days, substance abuse, accommodation status, labour market affiliation, and user satisfaction.” (1)

The integrated treatment offered:

  • Psychoeducation
  • Social skills training
  • Family involvement
  • One clinician who was responsible for “maintaining contact and coordinating treatment within the team and across different treatment and support facilities.” (1)

Major Findings:

  • At one year and two years’ follow-up, psychotic and negative symptoms were reduced more significantly for patients in the integrated treatment program
  • The reduction of psychotic symptoms cannot be attributed solely to drugs – in fact, patients in integrated treatment received significantly lower doses of SGAs {second generation antipsvchotics). See Limits of Medication for more information.
  • Patients who received integrated care demonstrated better adherence to treatment, less comorbid substance abuse, and more satisfaction with treatment
  • Integrated treatment improved clinical outcome more effectively than standard treatment, and this improvement remained consistent at one year and two year follow-ups.

Article: Integrated treatment ameliorates negative symptoms in first episode psychosis – results from the Danish OPUS trail

Authors: A. Thorup, L. Petersen, P. Jeppesen, et al.

This study investigated the effect of integrated treatment on negative, psychotic, and disorganized symptoms in patients with first episode psychosis. It compares Integrated Treatment (IT) with Standard Treatment (ST).

Background info: negative symptoms are much more resistant to treatment than psychotic (positive) symptoms, and affect a person’s ability to maintain and create sociai relationships.

The integrated treatment included:

  • Assertive community treatment
  • Social skills training
  • Psychoeducation
  • Multi-family group sessions
  • Amultidisciplinaryteam- psychiatrist, psychologist, psychiatric nurse, occupational therapist, and social worker
  • One primary staff member in charge of case coordination – “coordinating all of the treatment elements and social arrangements and maintaining] the primary contact with the patient” (98)
  • Weekly meetings between the patient and the case coordinator
  • Individual treatment plan made in cooperation with the patient

Major findings:

  • IT patients, versus ST patients, experienced a significantly greater improvement in both negative and psychotic symptoms
  • Integrated treatment reduces negative symptoms in first episode psychosis in all global scores of SANS (The Scale for Assessment of Negative Symptoms)
  • Integrated treatment’s effect on negative symptoms is not focused on any particular area, but applied widely to the range of negative symptoms
  • Patients in integrated treatment were less hospitalized, and received significantly lower doses of SGAs (second generation antipsychotics)
  • The significant improvements in patient health cannot be explained by one element of integrated treatment, but is a result of the integrated treatment as a whole

Article: Prospective evaluation of specialist inpatient treatment for refractory affective disorders

Authors: S. Wooderson, M. Juruena, A. Fekadu, et al.

This was an observational study on 225 patients admitted to the National Affective Disorders Unit! between 01/01/2001 and 10/15/2008 for a 4-6 weeks multimodal treatment program.

These patients had all exhibited highly treatment-resistant affective disorders; most had already received ECT (Electroconvulsive Therapy), lithium augmentation and over 10 prior treatment trials.

The comprehensive multidisciplinary treatment included:

  • Pharmacotherapy
  • Psychological therapy
  • Occupational therapy
  • Couple therapy
  • Physical therapies (ECT and assessment for suitability for neurosurgical interventions)
  • Supportive and enabling nursing care

Major findings:

  • 69% showed a clinical response to intensive therapy during admission; 50% continued to sustain a full response; 71% at least a partial response on discharge
  • Long admissions, gradual discharge, psychotherapy, family work and high-dose continuation medication contributed to the improvement in patients’ health
  • Specialist, multidisciplinary inpatient treatment can be effective even for patients with treatment-resistant depressive disorders