Effect of psychiatric consultation models in primary care. A systematic review and meta-analysis of randomized clinical trials

van der Feltz-Cornelis, Christina M.; Van Os, Titus W.D.P.; Van Marwijk, Harm W.J.; Leentjens, Albert F.G.

doi:10.1016/j.jpsychores.2009.10.012

« Previous Next »Journal of Psychosomatic Research
Volume 68, Issue 6 , Pages 521-533, June 2010

Effect of psychiatric consultation models in primary care. A systematic review and meta-analysis of randomized clinical trials☆☆☆★

Christina M. van der Feltz-Cornelis
- Diagnosis and Treatment of Common Mental Disorders, Trimbos-Instituut/Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
- Department of Psychiatry and the EMGO Institute for Health and Care Research, VUmc/GGZingeest, Amsterdam, The Netherlands
- Corresponding author. Diagnosis and Treatment of Common Mental Disorders, Trimbos-Instituut/Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, The Netherlands. Tel.: +31 30 2971126; fax: +31 30 2971111.
Titus W.D.P. Van Os
- Mental Health Care Friesland, Leeuwarden, The Netherlands
- Department of Psychiatry and Graduate School of Behavioral and Cognitive Neurosciences, University of Groningen, Groningen, The Netherlands
Harm W.J. Van Marwijk
- Department of General Practice and the EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
Albert F.G. Leentjens
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, The Netherlands

Received 5 July 2009; received in revised form 27 October 2009; accepted 27 October 2009. published online 18 January 2010.

Abstract

Objective

Psychiatric consultation in primary care is meant to enhance and improve treatment for mental disorder in that setting. An estimate of the effect for different conditions as well as identification of particularly effective elements is needed.

Methods

Database search for randomized controlled trials (RCTs) on psychiatric consultation in primary care. Validity assessment and data extraction according to Cochrane criteria were performed by independent assessors in duplicate. Meta-analysis was performed.

Results

Data were collected from 10 RCTs with a total of 3408 included patients with somatoform disorder or depressive disorder, which compared psychiatric consultation to care as usual (CAU). Meta-analysis irrespective of condition showed a weighted mean indicating a combined assessment of illness burden as outcome of psychiatric consultation, compared to CAU, of 0.313 (95% CI 0.190–0.437). The effect was especially large in somatoform disorder (0.614; 95% CI 0.206–1.022). RCTs in which after the consult, consultation advice was given by means of a consultation letter, showed a combined weighted mean effect size of 0.561 (95% CI 0.337–0.786), while studies not using such a letter showed a small effect of 0.210 (95% CI 0.102–0.319). Effects are highest on utilization of health care services with 0.507 (95% CI 0.305–0.708).

Conclusion

Psychiatric consultation in the primary care setting is effective in patients with somatoform and depressive disorder. Largest effects are seen in reduction of utilization of health care services.

Keywords: Psychiatric consultation, Meta-analysis, Systematic review, Primary care, Collaborative care, Somatoform disorder, Consultation letter