Improved Health Status and Decreased Utilization of an Anxious Phobic Man

  • Rodger Kessler
  • Dale Stafford

Patterson et al. accurately observed that success in collaborative and integrated care will occur only when the clinical, financial and operational levels of care are addressed. Conversely, the less attention paid to harmony in each of the three worlds, the less successful the outcome of collaboration. Less successful outcomes abound. While the US Preventative Services Task Force recommends routine screening of adults for depression, review of screening efforts finds that Three Worlds issues are rarely addressed and that there is little support for screening efforts changing patient care.3-4 At the same time, unrecognized and untreated or undertreated mental health and medical comorbidity result in higher, mostly medical, health care costs.

Despite a plethora of projects demonstrating the effectiveness of specific managing of depression and other comorbid mental health issues in primary care, and the positive effect on medical outcomes, such efforts are not part of standard care in most medical settings. While we know that behavioral treatments of comorbid medicalpsychological disorders can affect medical outcomes and impact utilization and cost, such treatments rarely are part of routine care. There is a high prevalence of patients in primary care with identified psychological disorders who do not receive optimal treatment despite frequent office visits. This ultimately results in limiting the availability of primary care practitioners, and often, increased medication costs.


Anxiety Symptom Behavioral Health Panic Disorder Collaborative Care Preventative Service Task 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Patterson J, Peek CJ, Heinrich RL, Bischoff RJ, Scherger J. Mental Health Professionals in Medical Settings: A Primer. New York: Norton; 2002.Google Scholar
  2. 2.
    U.S. Preventative Services Task Force. Screening for depression: recommendations and rationale. Ann Intern Med. 2002;136:765–776.Google Scholar
  3. 3.
    Coyne JC, Thompson R, Palmer SC, Kagee A, Maunsell EM. Should we screen for depression? Caveats and pitfalls. Appl Prev Psychol. 2000;9:101–121.CrossRefGoogle Scholar
  4. 4.
    Gilbody SM, House AO, Sheldon TA. Routinely administered questionnaires for depression and anxiety. Br Med J. 2001:322:406–409.CrossRefGoogle Scholar
  5. 5.
    Kathol R.G, McAlpine D, Kishi Y, et al. General medical and pharmacy claims expenditures in users of behavioral health services. J Gen Intern Med. 2005;20(2):160–167.PubMedCrossRefGoogle Scholar
  6. 6.
    Simon GE, VonKorff M, Barlow W. Health care costs of primary care patients with recognized depression. Arch Gen Psychiatry. 1995;52:850–856.PubMedGoogle Scholar
  7. 7.
    Katon W, Unutzer J. Collaborative care models for depression: time to move from evidence to practice. Arch Intern Med. 2006;166:2304–2306.PubMedCrossRefGoogle Scholar
  8. 8.
    Simon G. Collaborative care for depression is effective in older people. Br Med J. 2006;332:249–250.CrossRefGoogle Scholar
  9. 9.
    Gorcy TM, Kahn NB, McMillen MA. The future of family medicine: a collaborative project of the family medicine community. Ann Fam Med. 2004;2(1):S3–S32.CrossRefGoogle Scholar
  10. 10.
    Matalon A, Nahmani T, Rabin S, Maoz B, Jacob H. A short-term intervention in a multidisciplinary referral clinic for primary care frequent attenders: description of the model, patient characteristics, and their use of medical resources. Fam Pract. 2002;19(3):251–256.PubMedCrossRefGoogle Scholar
  11. 11.
    Peek CJ. Collaborative care: finding your latitude and longitude. Paper presented at: The Sixth Conference of the Collaborative Family Healthcare Association, 2004; Chaska, MN.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Rodger Kessler
    • Dale Stafford

      There are no affiliations available

      Personalised recommendations