A Multifaceted Intervention to Improve Treatment of Depression in Primary Care

Katon, Wayne; Robinson, Patricia J.; Korff, Michael Von; Lin, Elizabeth; Bush, Terry; Ludman, Evette; Simon, Gregory E.; Walker, Edward A.

doi:10.1001/archpsyc.1996.01830100072009

Cited by 758 publications

(544 citation statements)

References 29 publications

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“…[15][16][17] Collaborative models of chronic mental illness care that coordinate between primary care and care managers (CMs) are a proven approach to improving depression care in primary care settings. 8,[18][19][20] There is growing evidence that such collaborative care interventions may be adapted and implemented to address PTSD as well. But PTSD treatment is less routine in primary care and its care is more challenging because of barriers at the patient, physician and practice levels.…”

Section: Introductionmentioning

confidence: 99%

Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: a Randomized Controlled Trial

et al. 2016

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BACKGROUND:The effectiveness of collaborative care of mental health problems is clear for depression and growing but mixed for anxiety disorders, including posttraumatic stress disorder (PTSD). We know little about whether collaborative care can be effective in settings that serve low-income patients such as Federally Qualified Health Centers (FQHCs). OBJECTIVE: We compared the effectiveness of minimally enhanced usual care (MEU) versus collaborative care for PTSD with a care manager (PCM). DESIGN: This was a multi-site patient randomized controlled trial of PTSD care improvement over 1 year. PARTICIPANTS: We recruited and enrolled 404 patients in six FQHCs from June 2010 to October 2012. Patients were eligible if they had a primary care appointment, no obvious physical or cognitive obstacles to participation, were age 18-65 years, planned to continue care at the study location for 1 year, and met criteria for a past month diagnosis of PTSD. MAIN MEASURES: The main outcomes were PTSD diagnosis and symptom severity (range, 0-136) based on the Clinician-Administered PTSD Scale (CAPS). Secondary outcomes were medication and counseling for mental health problems, and health-related quality of life assessed at baseline, 6 months, and 12 months. KEY RESULTS: Patients in both conditions improved similarly over the 1-year evaluation period. At 12 months, PTSD diagnoses had an absolute decrease of 56.7 % for PCM patients and 60.6 % for MEU patients. PTSD symptoms decreased by 26.8 and 24.2 points, respectively. MEU and PCM patients also did not differ in process of care outcomes or health-related quality of life. Patients who actually engaged in care management had mental health care visits that were 14 % higher (p < 0.01) and mental health medication prescription rates that were 15.2 % higher (p < 0.01) than patients with no engagement. CONCLUSIONS:A minimally enhanced usual care intervention was similarly effective as collaborative care for patients in FQHCs.

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Section: Introductionmentioning

confidence: 99%

Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: a Randomized Controlled Trial

et al. 2016

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“…Provision of diagnostic information has not improved outcome appreciably in the UC arm of previous collaborative care studies. [4][5][6]15] …”

Section: Methodsmentioning

confidence: 99%

“…However, this approach would significantly reduce statistical powers, and we [15], and others [4,5,9], have successfully utilized randomization of patients without incurring any significant "spillover" effects where primary care physicians treat patients in both intervention and UC arms. RAND performed randomization procedures for eligible patients at all sites using a computerized random number generator.…”

Section: Randomizationmentioning

confidence: 99%

“…One approach to improve mental health care in primary care settings is the "collaborative care" model [4][5][6][7], closely patterned on the "chronic disease model" [8]. Various forms of the collaborative care model have been tested but some features are common to all.…”

Section: Introductionmentioning

confidence: 99%

“…Many collaborative care models have been shown to be both clinically and cost effective, yet these models are not yet widely-used and are rarely sustained beyond the period of external research funding, [4][5][6][7]9,19,20] though this now may be changing. [21] Because of the many barriers to funding for and implementation of collaborative care, making these interventions as "user-friendly" as possible is key to their successful dissemination.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Design of the Coordinated Anxiety Learning and Management (CALM) study: innovations in collaborative care for anxiety disorders

Sullivan

Craske

Sherbourne

et al. 2007

General Hospital Psychiatry

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Quality of Care for Primary Care Patients With Depression in Managed Care

Wells

Schoenbaum²,

Unützer³

et al. 1999

Archives of Family Medicine

109

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Rates of process and quality of care for depression as reported by patients are moderate to low in managed primary care practices. Such rates are higher for patients with more severe forms of depression or with comorbid anxiety, but not for those with severe but "silent" symptoms like suicide ideation. Visit context factors, such as whether the visit is scheduled, affect rates of depression-specific care. Rates of care for depression are highly variable among managed care organizations, emphasizing the need for process monitoring and quality improvement for depression at the organizational level.

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A Multifaceted Intervention to Improve Treatment of Depression in Primary Care

Cited by 758 publications

References 29 publications

Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: a Randomized Controlled Trial

Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: a Randomized Controlled Trial

Design of the Coordinated Anxiety Learning and Management (CALM) study: innovations in collaborative care for anxiety disorders

Quality of Care for Primary Care Patients With Depression in Managed Care

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