Cost-Effectiveness of Collaborative Care for Depression in a Primary Care Veteran Population

Liu, Chuan Fen; Hedrick, Susan C.; Chaney, Edmund F.; Heagerty, Patrick J.; Felker, Bradford; Hasenberg, Nicole M.; Fihn, Stephan D.; Katon, Wayne

doi:10.1176/appi.ps.54.5.698

Cited by 94 publications

(104 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[4][5][6] Methods for improving depression care in PC have been extensively studied and shown to be effective [7][8][9][10][11][12][13][14] and cost-effective. [15][16][17][18][19] Uptake of evidence-based models for improving depression care for PC populations, however, has been slow. [20][21][22][23][24] This paper aims to improve understanding of the uptake of depression care improvement models by investigating the determinants of adoption of three alternative, Veterans Affairs (VA) systemendorsed approaches to improving routine depression care.…”

Section: Introductionmentioning

confidence: 99%

Determinants of Readiness for Primary Care-Mental Health Integration (PC-MHI) in the VA Health Care System

et al. 2012

View full text Add to dashboard Cite

BACKGROUND: Depression management can be challenging for primary care (PC) settings. While several evidence-based models exist for depression care, little is known about the relationships between PC practice characteristics, model characteristics, and the practice's choices regarding model adoption. OBJECTIVE: We examined three Veterans Affairs (VA)-endorsed depression care models and tested the relationships between theoretically-anchored measures of organizational readiness and implementation of the models in VA PC clinics. DESIGN: 1) Qualitative assessment of the three VAendorsed depression care models, 2) Cross-sectional survey of leaders from 225 VA medium-to-large PC practices, both in 2007. MAIN MEASURES:We assessed PC readiness factors related to resource adequacy, motivation for change, staff attributes, and organizational climate. As outcomes, we measured implementation of one of the VA-endorsed models: collocation, Translating Initiatives in Depression into Effective Solutions (TIDES), and Behavioral Health Lab (BHL). We performed bivariate and, when possible, multivariate analyses of readiness factors for each model. KEY RESULTS: Collocation is a relatively simple arrangement with a mental health specialist physically located in PC. TIDES and BHL are more complex; they use standardized assessments and care management based on evidence-based collaborative care principles, but with different organizational requirements. By 2007, 107 (47.5 %) clinics had implemented collocation, 39 (17.3 %) TIDES, and 17 (7.6 %) BHL. Having established quality improvement processes (OR 2.30, [1.36,3.87], p=0.002) or a depression clinician champion (OR 2.36, [1.14, 4.88], p=0.02) was associated with collocation. Being located in a VA regional network that endorsed TIDES (OR 8.42, [3.69,19.26], p<0.001) was associated with TIDES implementation. The presence of psychologists or psychiatrists on PC staff, greater financial sufficiency, or greater spatial sufficiency was associated with BHL implementation. CONCLUSIONS: Both readiness factors and characteristics of depression care models influence model adoption. Greater model simplicity may make collocation attractive within local quality improvement efforts. Dissemination through regional networks may be effective for more complex models such as TIDES.

show abstract

Section: Introductionmentioning

confidence: 99%

Determinants of Readiness for Primary Care-Mental Health Integration (PC-MHI) in the VA Health Care System

et al. 2012

View full text Add to dashboard Cite

show abstract

“…The lower range of estimated costs would result if two telephone-based visits were included in each of three incremental visits. Telephone visits are less expensive, and there is substantial research indicating the effectiveness of telephone-based care in improving outcomes for patients newly starting antidepressants (29,31–33). Thus telephone visits may also play a role in efforts to reduce suicide.…”

Section: Discussionmentioning

confidence: 99%

“…Antidepressant costs may increase if closer monitoring results in more medication adjustments and increased adherence. To estimate potential incremental pharmacy costs associated with closer monitoring, we multiplied the mean cost of antidepressants in the first 12-week high-risk periods during FY 2004 ($121.42) by the observed increases in antidepressant adherence (15%–65%) reported during collaborative care interventions for depression (29–31). …”

Section: Methodsmentioning

confidence: 99%

Service Implications of Providing Intensive Monitoring During High-Risk Periods for Suicide Among VA Patients With Depression

Valenstein¹,

Eisenberg²,

McCarthy³

et al. 2009

Psychiatric Services

View full text Add to dashboard Cite

Objectives Department of Veterans Affairs (VA) patients in depression treatment have high suicide rates after psychiatric hospitalization, antidepressant starts, and dosage changes. Policy makers have recommended closer monitoring during these periods to reduce suicide. This study assessed the frequency of high-risk periods in clinical settings, the levels of monitoring provided during these periods, and the estimated costs of providing monitoring consistent with the most stringent Food and Drug Administration recommendation for treatment periods after antidepressant change (seven visits in the first 12 weeks). Methods Monitoring visits were identified in the 12-week period after antidepressant starts and dosage changes and after discharge from psychiatric hospitalization for 100,000 randomly selected VA patients in depression treatment between April 1, 1999, and September 30, 2004. Incremental costs of providing intensive monitoring were estimated by using VA Health Economics Resource Center average cost data. Results Patients averaged less than one high-risk period each year. They completed an average of 2.4 monitoring visits during the 12-week period after antidepressant treatment events and 4.9 visits after psychiatric hospitalization. Providing intensive monitoring would cost an additional $408–$537 for each high-risk period after antidepressant treatment events and $313–$341 for each high-risk period after psychiatric hospitalization. During fiscal year 2004 providing intensive monitoring during all high-risk periods would have cost an additional $183–$270 million. Providing intensive monitoring only after psychiatric hospitalizations would have cost an additional $15–$17 million. Conclusions Providing intensive monitoring for VA patients in depression treatment during all high-risk periods for suicide would require substantial services reorganization and incremental expenditures. Modest expenditures would support intensive monitoring during the highest-risk period that follows psychiatric hospitalization.

show abstract

“…En dos de los estudios se implementaron programas colaborativos entre especialistas de salud mental y equipos o médicos no especialistas que usaban tecnologías para su comunicación 12,13 . El programa colaborativo de Fortney y col realizado en atención primaria, fue más efectivo que el tratamiento usual respecto a variables de salud mental y calidad de vida; adicionalmente tuvo mejor evaluación usuaria 12 .…”

Section: Depresiónunclassified

“…El programa colaborativo de Fortney y col realizado en atención primaria, fue más efectivo que el tratamiento usual respecto a variables de salud mental y calidad de vida; adicionalmente tuvo mejor evaluación usuaria 12 . El programa colaborativo de Liu y col lograba mayor cantidad de días libres de depresión de las personas tratadas pero con un costo mayor 13 .…”

Section: Depresiónunclassified

Telepsiquiatría: una revisión sistemática cualitativa

Castro

Larraín²,

Fritsch

et al. 2012

Rev. méd. Chile

View full text Add to dashboard Cite

Cost-Effectiveness of Collaborative Care for Depression in a Primary Care Veteran Population

Cited by 94 publications

References 51 publications

Determinants of Readiness for Primary Care-Mental Health Integration (PC-MHI) in the VA Health Care System

Determinants of Readiness for Primary Care-Mental Health Integration (PC-MHI) in the VA Health Care System

Service Implications of Providing Intensive Monitoring During High-Risk Periods for Suicide Among VA Patients With Depression

Telepsiquiatría: una revisión sistemática cualitativa

Contact Info

Product

Resources

About