Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

For patients with chronic illness (diabetes, asthma, etc), what is the comparative effectiveness of interventions to address concomitant mental health issues on the outcomes of the primary chronic illness.

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

1. Are there advantages for primary care physicians to address both mental health and chronic illness compared with mental health issues being addressed by a separate mental health provider?
2. Is there evidence that if 2 such providers are separately providing care, that communication between the two (electronic health records, etc) improves the care of the chronic illness (or mental health issue)?

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Adult patients (though children would also apply) of either gender. the choice of the chronic illness would be that typically encountered in primary care practices (astham, diabetes, CHF). The mental health condition would be that commonly addressed in primary care practice (depression, anxiety, bipolar) or by mental health providers.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

It would indeed be of interest to see if there is research realted to the above related to different ethnic populations (African-American, Hispanic, etc)

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

1. Improved medication compliance or compliance with treatment recommendations
2. Improved patient or provider satisfaction
3. Improved patient healht care outcomes (reduced hospitalization, Hemoglobin A1c, etc)

Describe any health-related risks, side effects, or harms that you are concerned about.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Arthritis and nontraumatic joint disorders
• Cancer
• Cardiovascular disease, including stroke and hypertension
• Depression and other mental health disorders
• Diabetes mellitus
• Pulmonary disease/asthma

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Children
• Elderly
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

• Medicaid
• Medicare
• State Children's Health Insurance Program (SCHIP)

Importance

Describe why this topic is important.

Most comparative effectiveness (indeed most clinical research) addresses a single clinical condition. Yet in primary care, most patients have multiple "conditons" and with chronic illness, this often includes a mental health condition. The optimal management of this "muli-problem" individual is poorly known.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

Common clinical practice issue.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Evident from above. The primary care physician confronting the multi-problem patient with chronic illness(es)is often faced with the choice of what to deal with first, what to refer out, what to share with a referral provider, etc. Little is known as to what is best for the patient in these circumstances.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

Clearly this is a daily occurrence in primary care and the answer could be use to improve the care and care experience of patients with chronic illness

Describe the timeframe in which an answer to your question is needed.

Non-urgent

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

See above

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Clearly this is a daily occurrence in primary care and the answer could be use to improve the care and care experience of patients with chronic illness

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program