Effect of psychiatric consultation models in primary care. A systematic review and meta-analysis of randomized clinical trials☆☆☆★
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.
aDiagnosis and Treatment of Common Mental Disorders, Trimbos-Instituut/Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
bDepartment of Psychiatry and the EMGO Institute for Health and Care Research, VUmc/GGZingeest, Amsterdam, The Netherlands
cMental Health Care Friesland, Leeuwarden, The Netherlands
dDepartment of Psychiatry and Graduate School of Behavioral and Cognitive Neurosciences, University of Groningen, Groningen, The Netherlands
eDepartment of General Practice and the EMGO Institute for Health and Care Research, Amsterdam, The Netherlands
fDepartment of Psychiatry, Maastricht University Medical Center, Maastricht, 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.
☆ All authors declare that there are no competing interests.
☆☆ Ethics approval was not required for this article.
ABSTRACT