Implementing collaborative care to reduce depression for rural native American/Alaska native people

Abstract

Background: The purpose of this study was to identify the effects of Collaborative Care on rural Native American and Alaska Native (AI/AN) patients. Methods: Collaborative Care was implemented in three AI/AN serving clinics. Clinic staff participated in training and coaching designed to facilitate practice change. We followed clinics for 2 years to observe improvements in depression treatment and to examine treatment outcomes for enrolled patients. Collaborative Care elements included universal screening for depression, evidence-based treatment to target, use of behavioral health care managers to deliver the intervention, use of psychiatric consultants to provide caseload consultation, and quality improvement tracking to improve and maintain outcomes. We used t-tests to evaluate the main effects of Collaborative Care and used multiple linear regression to better understand the predictors of success. We also collected qualitative data from members of the Collaborative Care clinical team about their experience. Results: The clinics participated in training and practice coaching to implement Collaborative Care for depressed patients. Depression response (50% or greater reduction in depression symptoms as measured by the PHQ-9) and remission (PHQ-9 score less than 5) rates were equivalent in AI/AN patients as compared with White patients in the same clinics. Significant predictors of positive treatment outcome include only one depression treatment episodes during the study and more follow-up visits per patient. Clinicians were overall positive about their experience and the effect on patient care in their clinic. Conclusions: This project showed that it is possible to deliver Collaborative Care to AI/AN patients via primary care settings in rural areas.

The Effectiveness of Collaborative Care on Depression Outcomes for Racial/Ethnic Minority Populations in Primary Care: A Systematic Review

“…Asian adults (primarily East Asians) were included in 8 studies, 14,16,17,19,[27][28][29][30] and Native American adults were included in two studies. 15,31 Two studies specifically included individuals with co-morbid medical conditions (i.e. cardiometabolic syndrome 19 and type 2 diabetes mellitus 24 ).…”

Enhancing integrated psychosocial oncology through leveraging the oncology social worker's role in collaborative care

“…As a large, urban, multi‐institutional academic cancer center, our model may not generalize specifically to smaller cancer centers. However, CoCM has been shown to be flexible and adaptable to diverse healthcare settings, including small rural clinics, 36 by systematically focusing limited resources toward patients with the greatest need and leveraging remote telehealth consultation from psychiatric experts. In this study, we also focused on COSW perceptions of CoCM in 2017 and 2020, including aspects of patient care such as timely access and care quality, without correlation with patient reports or objective clinical outcomes.…”

Telepsychiatric Consultation as a Training and Workforce Development Strategy for Rural Primary Care

“…The formal training elements were part of a standard implementation approach of the Advancing Integrated Mental Health Solutions (AIMS) Center of the University of Washington, described in more detail elsewhere. 25 Briefly, formal training included a 1-day workshop for collaborative care model team members, We developed a conceptual model of training through telepsychiatric consultation based on team expertise and literature on educational learning models, including consultation, informal learning, and just-in-time learning (Figure 1). [26][27][28][29] We conceptualized consultation within an implementation science framework, in which consultants have both specific expertise in intervention strategies as well as knowledge and experience of applying these strategies in varied settings.…”