Improved health status and decreased utilization of an anxious phobic man

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.