Integrated Primary Care and Mental Health Service Utilization: A Meta-Analysis.

Abstract

Integrated primary care (IPC) is hypothesized to improve outcomes by increasing the use of mental health interventions. We aimed to conduct a meta-analytic evaluation of the effect of IPC models on the use of mental health services compared with usual or enhanced usual primary care. We searched the Medline, EMBASE, CENTRAL, PsycINFO, and SCOPUS databases for studies published from January 1, 1998, to December 15, 2024. A total of 9852 nonduplicate records were retrieved and 12 met inclusion criteria. We included published, peer-reviewed, randomized, and nonrandomized trials that evaluated an IPC intervention and included a comparator condition. We excluded trials with fewer than 10 participants in the treatment or comparator arms. Two independent reviewers screened abstracts, evaluated full texts, and extracted data. We conducted a multilevel meta-analysis to determine the odds ratios (ORs) of receiving treatment for participants in IPC vs comparator conditions. IPC resulted in increased odds of receiving any intervention (OR, 12.23; 95% CI, 3.64-41.07), a minimum dose of intervention (OR, 10.92; 95% CI, 3.28-36.32), and full course of intervention (OR, 19.17; 95% CI, 3.02-121.53) compared with usual and enhanced usual care. IPC significantly increased the reach of mental health services. Our study limitations included observing interstudy heterogeneity, identifying relatively few studies meeting inclusion criteria, and the authors not clearly articulating the integrated model employed. Additional research is needed to identify the specific elements of various IPC models that most contribute to increased access to and use of services.