Comparison of Collaborative Care and Colocation Treatment for Patients With Clinically Significant Depression Symptoms in Primary Care

Blackmore, Michelle A.; Carleton, Kelly E; Ricketts, Sarah M.; Patel, Uresh; Stein, Dana; Mallow, Alissa; Deluca, Joseph P.; Chung, Henry

doi:10.1176/appi.ps.201700569

Cited by 25 publications

(13 citation statements)

References 10 publications

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“…It is centered on evidence-based practices for management of depression as the new standard of care in primary care practice, and can be augmented with behavioral health integration in primary care settings using collaborative care, colocation, teletherapy, etc. 22,23 The project utilizes a point-of-care web-based application to (1) screen, (2) monitor depressive symptoms over time for patients who screen positive, and (3) guide the clinicians using MBC. The project requires all clinic staff to participate in up to 4 hours of face-to-face training that included didactic training on depression (prevalence, burden, comorbidity with medical disorders, and available treatment options using the MBC approach) and hands-on training with the web-based application.…”

Section: Quality-improvement Projectmentioning

confidence: 99%

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A Structured Approach to Detecting and Treating Depression in Primary Care: VitalSign6 Project

Jha¹,

Grannemann²,

Trombello³

et al. 2019

Ann Fam Med

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PURPOSE This report describes outcomes of an ongoing quality-improvement project (VitalSign6) in a large US metropolitan area to improve recognition, treatment, and outcomes of depressed patients in 16 primary care clinics (6 charity clinics, 6 federally qualified health care centers, 2 private clinics serving lowincome populations, and 2 private clinics serving patients with either Medicare or private insurance). METHODS Inclusion in this retrospective analysis was restricted to the first 25,000 patients (aged ≥12 years) screened with the 2-item Patient Health Questionnaire (PHQ-2) in the aforementioned quality-improvement project. Further evaluations with self-reports and clinician assessments were recorded for those with positive screen (PHQ-2 >2). Data collected from August 2014 though November 2016 were available at 3 levels: (1) initial PHQ-2 (n = 25,000), (2) positive screen (n = 4,325), and (3) clinician-diagnosed depressive disorder with 18 or more weeks of enrollment (n = 2,160). RESULTS Overall, 17.3% (4,325/25,000) of patients screened positive for depression. Of positive screens, 56.1% (2,426/4,325) had clinician-diagnosed depressive disorder. Of those enrolled for 18 or more weeks, 64.8% were started on measurement-based pharmacotherapy and 8.9% referred externally. Of the 1,400 patients started on pharmacotherapy, 45.5%, 30.2%, 12.6%, and 11.6% had 0, 1, 2, and 3 or more follow-up visits, respectively. Remission rates were 20.3% (86/423), 31.6% (56/177), and 41.7% (68/163) for those with 1, 2, and 3 or more follow-up visits, respectively. Baseline characteristics associated with higher attrition were: non-white, positive drug-abuse screen, lower depression/anxiety symptom severity, and younger age. CONCLUSION Although remission rates are high in those with 3 or more followup visits after routine screening and treatment of depression, attrition from care is a significant issue adversely affecting outcomes.

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Section: Quality-improvement Projectmentioning

confidence: 99%

“…Notes: Severity of depression 26 was defined using PHQ-9 as minimal (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), moderately severe (15)(16)(17)(18)(19), and severe (20)(21)(22)(23)(24)(25)(26)(27). Alcohol 32 and drug use 33 during the past year were screened with self-report measures.…”

Section: Patients In Primary Care Settings That Screened Positive Formentioning

confidence: 99%

A Structured Approach to Detecting and Treating Depression in Primary Care: VitalSign6 Project

Jha¹,

Grannemann²,

Trombello³

et al. 2019

Ann Fam Med

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“…A Cochrane review [ 41 ] found that collaborative care was associated with improved depression outcomes, increased antidepressant medication use, and enhanced mental health quality of life compared to care as usual at 0–6, 7–12, and 13–24 months. More recent studies have replicated this finding, with primary care patients enrolled in collaborative care programs reporting greater reductions in depressive symptoms and improvements in quality of life at 3 to 12 months follow-up compared to treatment as usual and co-location of behavioral health [ 42 – 44 ]. There has been an effort to disseminate collaborative care programs to more diverse populations, with encouraging results among racial/ethnic minorities [ 45 , 46 ] and patients with limited English language proficiency [ 47 ].…”

Section: Components Of Depression Treatment In the Pcmhmentioning

confidence: 91%

“…The empirical evidence supports collaborative care for depression. A Cochrane review [41] 12 months follow-up compared to treatment as usual and colocation of behavioral health [42][43][44]. There has been an effort to disseminate collaborative care programs to more diverse populations, with encouraging results among racial/ethnic minorities [45,46] and patients with limited English language proficiency [47].…”

Section: Components Of Depression Treatment In the Pcmhmentioning

confidence: 99%

The Role of the Patient-Centered Medical Home in Treating Depression

Bogucki

Williams

Solberg

et al. 2020

Curr Psychiatry Rep

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Purpose of Review This review discusses the role of the patient-centered medical home (PCMH) in treating depression, focusing on findings from primary care-based studies and their implications for the PCMH. Recent Findings Pharmacotherapy, psychotherapy, and collaborative care are evidence-based treatments for depression that can be delivered in primary care and extended to diverse populations. Recent research aligns with the core components of the PCMH model. Summary The core components of the PCMH are critical elements of depression treatment. Comprehensive care within the PCMH addresses medical and behavioral health concerns, including depression. Psychiatric and psychological care must be flexibly delivered so services remain accessible yet patient-centered. To ensure the quality and safety of treatment, depression symptoms must be consistently monitored. Coordination within and occasionally outside of the PCMH is needed to ensure patients receive the appropriate level of care. More research is needed to empirically evaluate depression treatment within the PCMH.

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“…With up to 70% of primary care visits prompted by psychosocial concerns, busy primary care clinicians must be able to recognize and manage complex behavioral health (BH) needs. 1 Integrating BH into primary care, although widely discussed as an effective strategy to improve access and outcomes, 2 can be challenging for fast-paced primary care clinics where personnel have varying levels of BH training and experience.…”

mentioning

confidence: 99%

Psychiatric Nurse Practitioners as Leaders in Behavioral Health Integration

Birch¹,

Ling²,

Phoenix³

2021

The Journal for Nurse Practitioners

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With up to 70% of primary care visits prompted by psychosocial concerns, busy primary care clinics are increasingly addressing complex behavioral health (BH) needs. Substantial evidence demonstrates that the integration of BH into primary care improves access and outcomes, yet clinics face significant challenges in real-world implementation. This collaborative care integration project used psychiatric mental health nurse practitioner faculty as integration and BH specialists at an urban primary care clinic serving a diverse and largely indigent population. The project weathered leadership changes, information system shortcomings, and a shift to telehealth during coronavirus disease 2019. The initial outcomes include increased levels of integration and improved depression and diabetes metrics.

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Comparison of Collaborative Care and Colocation Treatment for Patients With Clinically Significant Depression Symptoms in Primary Care

Cited by 25 publications

References 10 publications

A Structured Approach to Detecting and Treating Depression in Primary Care: VitalSign6 Project

A Structured Approach to Detecting and Treating Depression in Primary Care: VitalSign6 Project

The Role of the Patient-Centered Medical Home in Treating Depression

Psychiatric Nurse Practitioners as Leaders in Behavioral Health Integration

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