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Ishrat Husain M, Rodie DJ, Perivolaris A, Sanches M, Crawford A, Fitzgibbon KP, Levinson A, Geist R, Kurdyak P, Mitchell B, Oslin D, Sunderji N, Mulsant BH. A Collaborative-Care Telephone-Based Intervention for Depression, Anxiety, and at-Risk Drinking in Primary Care: The PARTNERs Randomized Clinical Trial. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:732-744. [PMID: 36855791 PMCID: PMC10517649 DOI: 10.1177/07067437231156243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Collaborative care (CC) could improve outcomes in primary care patients with common mental conditions. We assessed the effectiveness of a transdiagnostic model of telephone-based CC (tCC) delivered by lay providers to primary care patients with depression, anxiety, or at-risk drinking. METHODS PARTNERS was a pragmatic trial in 502 primary care adults presenting with depressive symptoms, anxiety symptoms, or at-risk drinking randomized to (1) usual care by primary care providers (PCPs) enhanced with the results of computer-assisted telephone-based assessments (at baseline and 4, 8, and 12 months later) (enhanced usual care [eUC]) or (2) tCC consisting of eUC plus frequent telephone coaching and psychoeducation provided by mental health technicians who also communicated to the PCP recommendations from a psychiatrist for evidence-based pharmacotherapy, psychotherapy, or, when indicated, referrals to mental health services. The primary analysis compared the change on the 9-item Patient Health Questionnaire (PHQ-9) in participants presenting with depression (n = 366) randomized to tCC versus eUC. Secondary analyses compared changes on the Generalized Anxiety Disorder-7 scale (GAD-7) in those presenting with anxiety (n = 298); or change in the number of weekly drinks in those presenting with at-risk drinking (n = 176). RESULTS There were no treatment or time×treatment effects between tCC and eUC on PHQ-9 scores for patients with depression during the 12-month follow-up. However, there was a treatment effect (tCC > eUC) on GAD-7 scores in those with anxiety and a time×treatment interaction effect on the number of weekly drinks (tCC > eUC) in those with at-risk drinking. CONCLUSION Implementing transdiagnostic tCC for common mental disorders using lay providers appears feasible in Canadian primary care. While tCC was not better than eUC for depression, there were some benefits for those with anxiety or at-risk drinking. Future studies will need to confirm whether tCC differentially benefits patients with depression, anxiety, or at-risk drinking.
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Affiliation(s)
- M. Ishrat Husain
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - David J. Rodie
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Marcos Sanches
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Allison Crawford
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Andrea Levinson
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rose Geist
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Hospital for Sick Children, Toronto, ON, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - David Oslin
- Department of Psychiatry, University of Pennsylvania and the Department of Veteran Affairs, Philadelphia, PA, USA
| | - Nadiya Sunderji
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
| | - Benoit H. Mulsant
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Ridout KK, Ridout SJ, Alavi M, Koshy MT, Harris B, Awsare S, Fazzolari L, Weisner CM, Iturralde E. Evaluating Implementation and Outcomes of the Achieving Depression and Anxiety Patient-Centered Treatment Collaborative Care Program in a Large, Integrated Health Care System: A Mixed Methods Observational Study Protocol. Perm J 2022; 26:39-48. [PMID: 36351884 PMCID: PMC9761276 DOI: 10.7812/tpp/22.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Collaborative care is an evidence-based multidisciplinary model shown to improve patient depression and anxiety outcomes. Although there is robust literature showing the effectiveness of collaborative care on depression and anxiety symptoms, there is little published on outcomes of collaborative care implementation or the efficacy of collaborative care compared with psychiatric referrals. Reported here is a study protocol examining a novel depression and anxiety collaborative care program in a large, integrated health care system. Methods This is a mixed methods study of the Achieving Depression and Anxiety Patient-Centered Treatment (ADAPT) program as compared to outpatient psychiatric care at Kaiser Permanente Northern California, a large, integrated health care delivery system. The ADAPT program was designed using collaborative care principles, including measurement-based care, accurate diagnosis, and population management. Eligible participants will be ≥ 18 years old with mild to moderate-severe depressive symptoms as measured by the Patient Health Questionnaire-9. Exclusion criteria include acute suicide risk and serious mental health comorbidities. Implementation is examined using the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework and interviews with program stakeholders. Results Pending. Conclusion Study data will help inform future collaborative care efforts while expanding the literature base. The Achieving Depression and Anxiety Patient-Centered Treatment program may improve patient outcomes and access to quality depression and/or anxiety care.
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Affiliation(s)
- Kathryn K Ridout
- 1The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA, USA,2Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA,Kathryn K Ridout, MD, PhD
| | - Samuel J Ridout
- 1The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Mubarika Alavi
- 2Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Maria T Koshy
- 1The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Brooke Harris
- 3Kaiser Foundation Hospitals, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Sameer Awsare
- 1The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Lisa Fazzolari
- 1The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Constance M Weisner
- 2Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Esti Iturralde
- 2Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
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Leung LB, Rubenstein LV, Jaske E, Taylor L, Post EP, Nelson KM, Rosland AM. Association of Integrated Mental Health Services with Physical Health Quality Among VA Primary Care Patients. J Gen Intern Med 2022; 37:3331-3337. [PMID: 35141854 PMCID: PMC9550947 DOI: 10.1007/s11606-021-07287-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Integrated care for comorbid depression and chronic medical disease improved physical and mental health outcomes in randomized controlled trials. The Veterans Health Administration (VA) implemented Primary Care-Mental Health Integration (PC-MHI) across all primary care clinics nationally to increase access to mental/behavioral health treatment, alongside physical health management. OBJECTIVE To examine whether widespread, pragmatic PC-MHI implementation was associated with improved care quality for chronic medical diseases. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included 828,050 primary care patients with at least one quality metric among 396 VA clinics providing PC-MHI services between October 2013 and September 2016. MAIN MEASURE(S) For outcome measures, chart abstractors rated whether diabetes and cardiovascular quality metrics were met for patients at each clinic as part of VA's established quality reporting program. The explanatory variable was the proportion of primary care patients seen by integrated mental health specialists in each clinic annually. Multilevel logistic regression models examined associations between clinic PC-MHI proportion and patient-level quality metrics, adjusting for regional, patient, and time-level effects and clinic and patient characteristics. KEY RESULTS Median proportion of patients seen in PC-MHI per clinic was 6.4% (IQR=4.7-8.7%). Nineteen percent of patients with diabetes had poor glycemic control (hemoglobin A1c >9%). Five percent had severely elevated blood pressure (>160/100 mmHg). Each two-fold increase in clinic PC-MHI proportion was associated with 2% lower adjusted odds of poor glycemic control (95% CI=0.96-0.99; p=0.046) in diabetes. While there was no association with quality for patients diagnosed with hypertension, patients without diagnosed hypertension had 5% (CI=0.92-0.99; p=0.046) lower adjusted odds of having elevated blood pressures. CONCLUSIONS AND RELEVANCE Primary care clinics where integrated mental health care reached a greater proportion of patients achieved modest albeit statistically significant gains in key chronic care quality metrics, providing optimism about the expected effects of large-scale PC-MHI implementation on physical health.
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Affiliation(s)
- Lucinda B Leung
- Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd (111G), Los Angeles, CA, 90073, USA. .,Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| | - Lisa V Rubenstein
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.,Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,RAND Corporation, Santa Monica, CA, USA
| | - Erin Jaske
- VA Puget Sound Health Care System, Seattle, WA, USA
| | | | - Edward P Post
- VA Ann Arbor, Center for Clinical Management Research, Ann Arbor, MI, USA.,Department of Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Karin M Nelson
- VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Medicine, University of Washington Medical School, Seattle, WA, USA
| | - Ann-Marie Rosland
- VA Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Blackmore MA, Patel UB, Stein D, Carleton KE, Ricketts SM, Ansari AM, Chung H. Collaborative Care for Low-Income Patients From Racial-Ethnic Minority Groups in Primary Care: Engagement and Clinical Outcomes. Psychiatr Serv 2022; 73:842-848. [PMID: 35139653 DOI: 10.1176/appi.ps.202000924] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess model impact and opportunities for improvement, this study examined collaborative care model (CoCM) engagement and clinical outcomes among low-income patients from racial-ethnic minority groups with depression and anxiety. METHODS Starting in 2015, the CoCM was implemented in seven primary care practices of an urban academic medical center serving patients from racial-ethnic minority backgrounds, predominantly Medicaid beneficiaries. Eligible individuals scored positive for depressive or anxiety symptoms (or both) on the Patient Health Questionnaire-2 (PHQ-2) and PHQ-9 and the Generalized Anxiety Disorder Scale-2 (GAD-2) and GAD-7 during systematic screening in primary care settings. Screening rates and yield, patient characteristics, and CoCM engagement and outcomes were examined. Clinical improvement was measured by the difference in PHQ-9 and GAD-7 scores at baseline and at 10-to-14-week follow-up. RESULTS High rates of screening (87%, N=88,236 of 101,091) and identification of individuals with depression or anxiety (13%, N=11,886) were observed, and 58% of 3,957 patients who engaged in minimally adequate CoCM treatment had significant clinical improvement. Nevertheless, only 56% of eligible patients engaged in the model, and 25% of those individuals did not return for at least one follow-up appointment. Being female with clinically significant comorbid anxiety and depressive symptoms and having Medicaid or commercial insurance increased the likelihood of CoCM engagement. CONCLUSIONS CoCM can help engage vulnerable patients in behavioral health care and improve clinical symptoms. However, significant opportunity exists to advance the model's impact in treating depressive and anxiety disorders and decreasing health disparities by addressing engagement barriers.
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Affiliation(s)
- Michelle A Blackmore
- Montefiore Care Management Organization (Blackmore, Ricketts), Einstein College of Medicine (Patel, Chung), and Montefiore Medical Group (Ansari), Montefiore Health System, Yonkers, New York; CareMount Medical, Population Health (Stein), and Mantra Health (Carleton), New York City
| | - Urvashi B Patel
- Montefiore Care Management Organization (Blackmore, Ricketts), Einstein College of Medicine (Patel, Chung), and Montefiore Medical Group (Ansari), Montefiore Health System, Yonkers, New York; CareMount Medical, Population Health (Stein), and Mantra Health (Carleton), New York City
| | - Dana Stein
- Montefiore Care Management Organization (Blackmore, Ricketts), Einstein College of Medicine (Patel, Chung), and Montefiore Medical Group (Ansari), Montefiore Health System, Yonkers, New York; CareMount Medical, Population Health (Stein), and Mantra Health (Carleton), New York City
| | - Kelly E Carleton
- Montefiore Care Management Organization (Blackmore, Ricketts), Einstein College of Medicine (Patel, Chung), and Montefiore Medical Group (Ansari), Montefiore Health System, Yonkers, New York; CareMount Medical, Population Health (Stein), and Mantra Health (Carleton), New York City
| | - Sarah M Ricketts
- Montefiore Care Management Organization (Blackmore, Ricketts), Einstein College of Medicine (Patel, Chung), and Montefiore Medical Group (Ansari), Montefiore Health System, Yonkers, New York; CareMount Medical, Population Health (Stein), and Mantra Health (Carleton), New York City
| | - Asif M Ansari
- Montefiore Care Management Organization (Blackmore, Ricketts), Einstein College of Medicine (Patel, Chung), and Montefiore Medical Group (Ansari), Montefiore Health System, Yonkers, New York; CareMount Medical, Population Health (Stein), and Mantra Health (Carleton), New York City
| | - Henry Chung
- Montefiore Care Management Organization (Blackmore, Ricketts), Einstein College of Medicine (Patel, Chung), and Montefiore Medical Group (Ansari), Montefiore Health System, Yonkers, New York; CareMount Medical, Population Health (Stein), and Mantra Health (Carleton), New York City
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Implementation and Qualitative Evaluation of a Primary Care Redesign Model with Expanded Scope of Work for Medical Assistants. J Gen Intern Med 2022; 37:1129-1137. [PMID: 34997393 PMCID: PMC8971214 DOI: 10.1007/s11606-021-07246-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Implementation of primary care models involving expanded scope of work and redesigned workflows for medical assistants (MAs) as primary care team members can be challenging. Implementation strategies and participatory evaluation informed by implementation science frameworks may inform organizational decisions about model scale-up and sustainment. OBJECTIVE This paper reports implementation strategies and qualitative evaluation of a primary care redesign (PCR) model implementation that included an expanded scope of work for MAs. DESIGN Qualitative evaluation of implementation strategies and clinician and staff experience with implementation of PCR using semi-structured key informant interviews. The evaluation was guided by the RE-AIM framework and the Consolidated Framework for Implementation Research. PARTICIPANTS Sixty-nine clinicians, staff, practice leaders, and administrators from 7 primary care practices (4 general internal medicine, 3 family medicine) implementing PCR. INTERVENTIONS The PCR model included enhanced rooming and documentation support. The health system used multiple strategies to implement PCR, including rapid improvement events, changing clinic space configurations, developing electronic health record templates and performance dashboards, and practice coaching. APPROACH The Consolidated Framework for Implementation Research and the RE-AIM evaluation and planning framework guided development of semi-structured interview guides. A deductive, structural coding approach was used for analysis. KEY RESULTS PCR implementation was facilitated by clear communication about the intervention source, mechanisms for feedback about model goals, and physical environments and electronic health record (EHR) systems that supported the added staff and modified clinic workflow. Clinicians and staff benefited from the ability to see the model in action prior to go-live and opportunities for consistent provider-MA pairings. CONCLUSIONS The PCR model can support achieving the Quadruple Aim when fully implemented with paired MAs and clinicians who are well prepared to follow redesigned workflows and function as a team. Implementation can be effectively supported by a participatory evaluation guided by implementation science frameworks.
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Wang MZ, Jha MK, Minhajuddin A, Pipes R, Levinson S, Mayes TL, Greer TL, Trivedi MH. A primary care first (PCP-first) model to screen and treat depression: A VitalSign 6 report from a second cohort of 32,106 patients. Gen Hosp Psychiatry 2022; 74:1-8. [PMID: 34784574 DOI: 10.1016/j.genhosppsych.2021.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE This report from VitalSign6 project describes treatment selection, follow-up rates and remission outcomes by initial depression severity using the PCP-FIRST model. METHODS This retrospective analysis included 32,106 patients aged ≥12 years screened with the Patient Health Questionnaire 2-item (PHQ-2) from November 2016 to July 2019 across 37 primary care clinics. PHQ-2 positive-screen patients (PHQ-2 ≥ 3) received 9-item PHQ (PHQ-9) and 7-item Generalized Anxiety Disorder scales, clinician assessments, and evaluation for pharmacotherapy management with measurement-based care (MBC). RESULTS Of PHQ-2 screened patients, 18.7% (5994/32,106) were positive and received a PHQ-9. Of 5994 patients with PHQ-9, 2571 received a clinical diagnosis of depression of whom, 333 had none-mild depression (PHQ-9 < 10) and 2238 had moderate-severe depression (PHQ-9 ≥ 10). Of the 333 patients with none-mild depression and 2238 patients with moderate-severe depression, 266 and 1929 had at least 18 weeks of data available. Of these, 54.9% (146/266) with none-mild depression and 69.1% (1332/1929) with moderate-severe depression were started on pharmacotherapy. Of the 1478 patients with clinical diagnosis of depression, initiated on pharmacotherapy, 1046 returned for ≥1 follow-up and 616 returned for ≥3 follow-ups over 18 weeks. Of the 1046 patients with ≥1 follow-up visit within 18 weeks, remission rates for patients with mild depression, moderate-severe depression, and overall were 55.6% (66/99), 30% (282/941), and 32.4% (338/1040) respectively. CONCLUSIONS Despite this being a real-world, usual care sample, remission outcomes exceed real world remission rate expectations of 6% in primary care.
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Affiliation(s)
- Margaret Z Wang
- Center for Depression Research and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States; Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, United States.
| | - Manish K Jha
- Center for Depression Research and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States; Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, United States.
| | - Abu Minhajuddin
- Center for Depression Research and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States; Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, United States; Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, United States.
| | - Ronny Pipes
- Center for Depression Research and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States; Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, United States.
| | - Sara Levinson
- Center for Depression Research and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States; Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, United States.
| | - Taryn L Mayes
- Center for Depression Research and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States; Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, United States.
| | - Tracy L Greer
- Center for Depression Research and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States; Department of Psychology, University of Texas at Arlington, Arlington, TX, United States.
| | - Madhukar H Trivedi
- Center for Depression Research and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States; Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, United States.
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Miller ES, Grobman WA, Ciolino JD, Zumpf K, Sakowicz A, Gollan J, Wisner KL. Increased Depression Screening and Treatment Recommendations After Implementation of a Perinatal Collaborative Care Program. Psychiatr Serv 2021; 72:1268-1275. [PMID: 34015950 DOI: 10.1176/appi.ps.202000563] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study evaluated whether implementation of perinatal collaborative care is associated with improvements in screening and treatment recommendations for perinatal depression by obstetric clinicians. METHODS This cohort study, conducted from January 2015 to January 2019, included all women who received prenatal care in five obstetric clinics and delivered at a single quaternary care hospital in Chicago. In January 2017, a perinatal collaborative care program (COMPASS) was implemented. Completion of depression screening and recommendations for treatment following a positive depression screen were compared before and after COMPASS implementation. Adjusted analyses included inverse probability weighting by using propensity scores to impose control over imbalance between exposure groups with respect to prespecified covariates. RESULTS A total of 7,028 women were included in these analyses: 3,227 (46%) before and 3,801 (54%) after COMPASS implementation. Women who received obstetric care after implementation were significantly more likely than those who received care before implementation to receive antenatal screening for depression (81% versus 33%; adjusted odds ratio [aOR]=8.5, 95% confidence interval [CI]=7.6-9.5). After implementation, women with a positive antenatal screen for depression were more likely to receive a treatment recommendation (61% versus 44%; aOR=2.1, 95% CI=1.2-3.7). After implementation of perinatal collaborative care, combined psychotherapy and pharmacotherapy were more frequently recommended, compared with before implementation. CONCLUSIONS Implementation of a perinatal collaborative care program was associated with improvements in perinatal depression screening and recommendations for treatment by obstetric clinicians.
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Affiliation(s)
- Emily S Miller
- Department of Obstetrics and Gynecology (Miller, Grobman, Sakowicz), Department of Psychiatry and Behavioral Sciences (Miller, Gollan, Wisner), and Department of Preventive Medicine, Division of Biostatistics (Ciolino, Zumpf), all at Feinberg School of Medicine, Northwestern University, Chicago
| | - William A Grobman
- Department of Obstetrics and Gynecology (Miller, Grobman, Sakowicz), Department of Psychiatry and Behavioral Sciences (Miller, Gollan, Wisner), and Department of Preventive Medicine, Division of Biostatistics (Ciolino, Zumpf), all at Feinberg School of Medicine, Northwestern University, Chicago
| | - Jody D Ciolino
- Department of Obstetrics and Gynecology (Miller, Grobman, Sakowicz), Department of Psychiatry and Behavioral Sciences (Miller, Gollan, Wisner), and Department of Preventive Medicine, Division of Biostatistics (Ciolino, Zumpf), all at Feinberg School of Medicine, Northwestern University, Chicago
| | - Katelyn Zumpf
- Department of Obstetrics and Gynecology (Miller, Grobman, Sakowicz), Department of Psychiatry and Behavioral Sciences (Miller, Gollan, Wisner), and Department of Preventive Medicine, Division of Biostatistics (Ciolino, Zumpf), all at Feinberg School of Medicine, Northwestern University, Chicago
| | - Allie Sakowicz
- Department of Obstetrics and Gynecology (Miller, Grobman, Sakowicz), Department of Psychiatry and Behavioral Sciences (Miller, Gollan, Wisner), and Department of Preventive Medicine, Division of Biostatistics (Ciolino, Zumpf), all at Feinberg School of Medicine, Northwestern University, Chicago
| | - Jacqueline Gollan
- Department of Obstetrics and Gynecology (Miller, Grobman, Sakowicz), Department of Psychiatry and Behavioral Sciences (Miller, Gollan, Wisner), and Department of Preventive Medicine, Division of Biostatistics (Ciolino, Zumpf), all at Feinberg School of Medicine, Northwestern University, Chicago
| | - Katherine L Wisner
- Department of Obstetrics and Gynecology (Miller, Grobman, Sakowicz), Department of Psychiatry and Behavioral Sciences (Miller, Gollan, Wisner), and Department of Preventive Medicine, Division of Biostatistics (Ciolino, Zumpf), all at Feinberg School of Medicine, Northwestern University, Chicago
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The effectiveness of enhanced evidence-based care for depressive disorders: a meta-analysis of randomized controlled trials. Transl Psychiatry 2021; 11:531. [PMID: 34657142 PMCID: PMC8520525 DOI: 10.1038/s41398-021-01638-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 08/13/2021] [Accepted: 09/08/2021] [Indexed: 11/26/2022] Open
Abstract
Several care models have been developed to improve treatment for depression, all of which provide "enhanced" evidence-based care (EEC). The essential component of these approaches is Measurement-Based Care (MBC). Specifically, Collaborative Care (CC), and Algorithm-guided Treatment (AGT), and Integrated Care (IC) all use varying forms of rigorous MBC assessment, care management, and/or treatment algorithms as key instruments to optimize treatment delivery and outcomes for depression. This meta-analysis systematically examined the effectiveness of EEC versus usual care for depressive disorders based on cluster-randomized studies or randomized controlled trials (RCTs). PubMed, the Cochrane Library, and PsycInfo, EMBASE, up to January 6th, 2020 were searched for this meta-analysis. The electronic search was supplemented by a manual search. Standardized mean difference (SMD), risk ratio (RR), and their 95% confidence intervals (CIs) were calculated and analyzed. A total of 29 studies with 15,255 participants were analyzed. EEC showed better effectiveness with the pooled RR for response of 1.30 (95%CI: 1.13-1.50, I2 = 81.9%, P < 0.001, 18 studies), remission of 1.35 (95%CI: 1.11-1.64, I2 = 85.5%, P < 0.001, 18 studies) and symptom reduction with a pooled SMD of -0.42 (95%CI: -0.61-(-0.23), I2 = 94.3%, P < 0.001, 19 studies). All-cause discontinuations were similar between EEC and usual care with the pooled RR of 1.08 (95%CI: 0.94-1.23, I2 = 68.0%, P = 0.303, 27 studies). This meta-analysis supported EEC as an evidence-based framework to improve the treatment outcome of depressive disorders.Review registration: PROSPERO: CRD42020163668.
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Collaborative care for depression management in primary care: A randomized roll-out trial using a type 2 hybrid effectiveness-implementation design. Contemp Clin Trials Commun 2021; 23:100823. [PMID: 34401595 PMCID: PMC8350002 DOI: 10.1016/j.conctc.2021.100823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/11/2021] [Accepted: 07/24/2021] [Indexed: 12/20/2022] Open
Abstract
Background The Collaborative Care Model (CoCM) is a well-established treatment for depression in primary care settings. The critical drivers and specific strategies for improving implementation and sustainment are largely unknown. Rigorous pragmatic research is needed to understand CoCM implementation processes and outcomes. Methods This study is a hybrid Type 2 randomized roll-out effectiveness-implementation trial of CoCM in 11 primary care practices affiliated with an academic medical center. The Collaborative Behavioral Health Program (CBHP) was developed as a means of improving access to effective mental health services for depression. Implementation strategies are provided to all practices. Using a sequential mixed methods approach, we will assess key stakeholders’ perspectives on barriers and facilitators of implementation and sustainability of CBHP. The speed and quantity of implementation activities completed over a 30-month period for each practice will be assessed. Economic analyses will be conducted to determine the budget impact and cost offset of CBHP in the healthcare system. We hypothesize that CBHP will be effective in reducing depressive symptoms and spillover effects on chronic health conditions. We will also examine differential outcomes among racial/ethnic minority patients. Discussion This study will elucidate critical drivers of successful CoCM implementation. It will be among the first to conduct economic analyses on a fee-for-service model utilizing billing codes for CoCM. Data may inform ways to improve implementation efficiency with an optimization approach to successive practices due to the roll-out design. Changes to the protocol and current status of the study are discussed.
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Steel JL, Reyes V, Zandberg DP, Nilsen M, Terhorst L, Richards G, Pappu B, Kiefer G, Johnson J, Antoni M, Vodovotz Y, Spring M, Walker J, Geller DA. The next generation of collaborative care: The design of a novel web-based stepped collaborative care intervention delivered via telemedicine for people diagnosed with cancer. Contemp Clin Trials 2021; 105:106295. [PMID: 33556589 DOI: 10.1016/j.cct.2021.106295] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 01/12/2021] [Accepted: 01/22/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The NIH consensus statement on cancer-related symptoms concluded the most common and debilitating were depression, pain and fatigue [1-6]. Although the comorbidity of these symptoms is well known and may have similar underlying biological mechanisms no intervention has been developed to reduce these symptoms concurrently. The novel web-based stepped collaborative care intervention delivered by telemedicine is the first to be tested in people diagnosed with cancer. METHODS We plan to test a web-based stepped collaborative care intervention with 450 cancer patients and 200 caregivers in the context of a randomized controlled trial. The primary endpoint is quality of life with other primary outcomes including patient-reported depression, pain, fatigue. Secondary outcomes include patient serum levels of pro-inflammatory cytokines and disease progression. We also will assess informal caregiver stress, depression, and metabolic abnormalities to determine if improvements in patients' symptoms also relate to improvement in caregiver outcomes. RESULTS The trial is ongoing and a total of 382 patients have been randomized. Preliminary analyses of the screening tools used for study entry suggest that Center for Epidemiological Studies-Depression (CESD) scale has good sensitivity and specificity (0.81 and 0.813) whereas the scale used to assess pain (0.47 and 0.91) and fatigue (0.11 and 0.91) had poor sensitivity but excellent specificity. Using the AUROC, the best cut point for the CES-D was 19, for pain was 4.5; and for fatigue was 2.5. Outcomes not originally proposed included health care utilization and healthcare charges. The first 100 patients who have been followed a year post-treatment, and who were less than 75 years and randomized to the web-based stepped collaborative care intervention, had lower rates of complications after surgery [χ2 = 5.45, p = 0.02]. For patients who survived 6 months or less and were randomized to the web-based stepped collaborative care intervention, had lower rates of 90-day readmissions when compared to patients randomized to the screening and referral arm [χ2 = 4.0, p = 0.046]. Patients randomized to the collaborative care intervention arm had lower overall health care activity-based costs of $16,758 per patient per year when compared to the screening and referral arm. DISCUSSION This novel web-based stepped stepped collaborative care intervention, delivered via telemedicine, is expected to provide a new strategy to improve the quality of life in those diagnosed with cancer and their caregivers. TRIAL REGISTRATION ClinicalTrials.govNCT02939755.
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Rodie DJ, Fitzgibbon K, Perivolaris A, Crawford A, Geist R, Levinson A, Mitchell B, Oslin D, Sunderji N, Mulsant BH. The primary care assessment and research of a telephone intervention for neuropsychiatric conditions with education and resources study: Design, rationale, and sample of the PARTNERs randomized controlled trial. Contemp Clin Trials 2021; 103:106284. [PMID: 33476774 DOI: 10.1016/j.cct.2021.106284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 11/25/2022]
Abstract
While most patients with depression, anxiety, or at-risk drinking receive care exclusively in primary care settings, primary care providers experience challenges in diagnosing and treating these common problems. Over the past two decades, the collaborative care model has addressed these challenges. However, this model has been adopted very slowly due to the high costs of care managers; inability to sustain their role in small practices; and the perceived lack of relevance of interventions focused on a specific psychiatric diagnosis. Thus, we designed an innovative randomized clinical trial (RCT), the Primary Care Assessment and Research of a Telephone Intervention for Neuropsychiatric Conditions with Education and Resources study (PARTNERs). This RCT compared the outcomes of enhanced usual care and a novel model of collaborative care in primary care patients with depressive disorders, generalized anxiety, social phobia, panic disorder, at-risk drinking, or alcohol use disorders. These conditions were selected because they are present in almost a third of patients seen in primary care settings. Innovations included assigning the care manager role to trained lay providers supported by computer-based tools; providing all care management centrally by phone - i.e., the intervention was delivered without any face-to-face contact between the patient and the care team; and basing patient eligibility and treatment selection on a transdiagnostic approach using the same eligibility criteria and the same treatment algorithms regardless of the participants' specific psychiatric diagnosis. This paper describes the design of this RCT and discusses the rationale for its main design features.
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Affiliation(s)
- David J Rodie
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | | | - Allison Crawford
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Rose Geist
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Hospital for Sick Children, Toronto, ON, Canada
| | - Andrea Levinson
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - David Oslin
- University of Pennsylvania and the Department of Veteran Affairs, Philadelphia, PA, United States of America
| | - Nadiya Sunderji
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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A Roadmap for Institutionalizing Collaborative Care for Depression in a Large Integrated Healthcare System. J Gen Intern Med 2020; 35:839-848. [PMID: 33107004 PMCID: PMC7652957 DOI: 10.1007/s11606-020-06102-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 07/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Collaborative models for depression have not been widely adopted throughout the USA, possibly because there are no successful roadmaps for implementing these types of models. OBJECTIVE To provide such a roadmap through a case study of the institutionalization of a depression care management (DCM) initiative for adult depression in a large healthcare system serving over 300,000 adults with depression. DESIGN A retrospective observational program evaluation. Program evaluation results are presented for those patients enrolled in the initiative from January 1, 2015, to December 31, 2018. PARTICIPANTS Over a 4-year period, 17,052 patients were treated in the DCM program. In general, participants were women (76%), were Hispanic (47%), spoke English (84%), and were 51.1 ± 18.3 years old, the majority of whom were 30-64 years old (57%). INTERVENTION The collaborative care portion of the DCM initiative (DCM program) was implemented by a collaborative care team containing a treatment specialist, an assessment specialist, administrative staff, a primary care physician, and a psychiatry physician. MAIN MEASURES The main outcome measures were total score on the 9-item Patient Health Questionnaire (PHQ-9). Outcomes were improvement (defined as at least 50% reduction in symptoms) and remission (defined as a PHQ-9 less than 5) of depression symptoms. Follow-up of depression symptoms was also collected at 6 months following discharge. KEY RESULTS The average course of treatment in 2018, after full implementation, was 4.6 ± 3.0 months; 62% of patients experienced improvement in symptoms, and 45% experienced remission of their depression at the time of discharge. These rates were maintained at the 6-month follow-up. CONCLUSIONS Collaborative care for depression can be institutionalized in large healthcare systems and be sustained with a specific, detailed roadmap that includes workflows, training, treatment guidelines, and clear documentation standards that are linked to performance metrics. Extensive stakeholder engagement at every level is also critical for success.
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The Impact of Systematic Depression Screening in Primary Care on Depression Identification and Treatment in a Large Health Care System: A Cohort Study. J Gen Intern Med 2020; 35:3141-3147. [PMID: 32495093 PMCID: PMC7661597 DOI: 10.1007/s11606-020-05856-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 04/13/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Unless implementation of systematic depression screening is associated with timely treatment, quality measures based on screening are unlikely to improve outcomes. OBJECTIVE To assess the impact of integrating systematic depression screening with clinical decision support on depression identification and treatment. DESIGN Retrospective pre-post study. PARTICIPANTS Adults with a primary care visit within a large integrated health system in 2016 were included. Adults diagnosed with depression in 2015 or prior to their initial primary care visit in 2016 were excluded. INTERVENTION Initiation of systematic screening using the Patient Health Questionnaire (PHQ) which began in mid-2016. MAIN MEASURES Depression diagnosis was based on ICD codes. Treatment was defined as (1) antidepressant prescription, (2) referral, or (3) evaluation by a behavioral health specialist. We used an adjusted linear regression model to identify whether the percentage of visits with a depression diagnosis was different before versus after implementation of systematic screening. An adjusted multilevel regression model was used to evaluate the association between screening and odds of treatment. KEY RESULTS Our study population included 259,411 patients. After implementation, 59% of patients underwent screening. Three percent scored as having moderate to severe depression. The rate of depression diagnosis increased by 1.2% immediately after systematic screening (from 1.7 to 2.9%). The percent of patients with diagnosed depression who received treatment within 90 days increased from 64% before to 69% after implementation (p < 0.01) and the adjusted odds of treatment increased by 20% after implementation (AOR 1.20, 95% CI 1.12-1.28, p < 0.01). CONCLUSIONS Implementing systematic depression screening within a large health care system led to high rates of screening and increased rates of depression diagnosis and treatment.
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McGinty EE, Daumit GL. Integrating Mental Health and Addiction Treatment Into General Medical Care: The Role of Policy. Psychiatr Serv 2020; 71:1163-1169. [PMID: 32487007 PMCID: PMC7606646 DOI: 10.1176/appi.ps.202000183] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Interventions that integrate care for mental illness or substance use disorders into general medical care settings have been shown to improve patient outcomes in clinical trials, but efficacious models are complex and difficult to scale up in real-world practice settings. Existing payment policies have proven inadequate to facilitate adoption of effective integrated care models. This article provides an overview of evidence-based models of integrated care, discusses the key elements of such models, considers how existing policies have fallen short, and outlines future policy strategies. Priorities include payment policies that adequately support structural elements of integrated care and incentivize multidisciplinary team formation and accountability for patient outcomes, as well as policies to expand the specialty mental health and addiction treatment workforce and address the social determinants of health that disproportionately influence health and well-being among people with mental illness or substance use disorders.
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Affiliation(s)
- Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health (McGinty), and Division of General Internal Medicine, Johns Hopkins School of Medicine (Daumit), Baltimore
| | - Gail L Daumit
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health (McGinty), and Division of General Internal Medicine, Johns Hopkins School of Medicine (Daumit), Baltimore
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Fortney JC, Heagerty PJ, Bauer AM, Cerimele JM, Kaysen D, Pfeiffer PN, Zielinski MJ, Pyne JM, Bowen D, Russo J, Ferro L, Moore D, Nolan JP, Fee FC, Heral T, Freyholtz-London J, McDonald B, Mullins J, Hafer E, Solberg L, Unützer J. Study to promote innovation in rural integrated telepsychiatry (SPIRIT): Rationale and design of a randomized comparative effectiveness trial of managing complex psychiatric disorders in rural primary care clinics. Contemp Clin Trials 2020; 90:105873. [PMID: 31678410 DOI: 10.1016/j.cct.2019.105873] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Managing complex psychiatric disorders like PTSD and bipolar disorder is challenging in Federally Qualified Health Centers (FQHCs) delivering care to U.S residents living in underserved rural areas. This protocol paper describes SPIRIT, a pragmatic comparative effectiveness trial designed to compare two approaches to managing PTSD and bipolar disorder in FQHCs. INTERVENTIONS Treatment comparators are: 1) Telepsychiatry Collaborative Care, which integrates consulting telepsychiatrists into primary care teams, and 2) Telepsychiatry Enhanced Referral, where telepsychiatrists and telepsychologists treat patients directly. METHODS Because Telepsychiatry Enhanced Referral is an adaptive intervention, a Sequential, Multiple Assignment, Randomized Trial design is used. Twenty-four FQHC clinics without on-site psychiatrists or psychologists are participating in the trial. The sample is patients screening positive for PTSD and/or bipolar disorder who are not already engaged in pharmacotherapy with a mental health specialist. Intervention fidelity is measured but not controlled. Patient treatment engagement is measured but not required, and intent-to-treat analysis will be used. Survey questions measure treatment engagement and effectiveness. The Short-Form 12 Mental Health Component Summary (SF-12 MCS) is the primary outcome. RESULTS A third (34%) of those enrolled (n = 1004) are racial/ethnic minorities, 81% are not fully employed, 68% are Medicaid enrollees, 7% are uninsured, and 62% live in poverty. Mental health related quality of life (SF-12 MCS) is 2.5 standard deviations below the national mean. DISCUSSION We hypothesize that patients randomized to Telepsychiatry Collaborative Care will have better outcomes than those randomized to Telepsychiatry Enhanced Referral because a higher proportion will engage in evidence-based treatment.
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Affiliation(s)
- John C Fortney
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA; Department of Veterans Affairs, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.
| | - Patrick J Heagerty
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
| | - Amy M Bauer
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Joseph M Cerimele
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Paul N Pfeiffer
- University of Michigan Medical School, Ann Arbor, MI, USA; Department of Veterans Affairs, Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Melissa J Zielinski
- Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeffrey M Pyne
- Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA; Department of Veterans Affairs, Health Services Research and Development, Center for Mental Healthcare and Outcomes Research, Little Rock, AR, USA
| | - Deb Bowen
- Department of Bioethics and Humanities, University of Washington, Seattle, WA, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Lori Ferro
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Danna Moore
- Social and Economic Sciences Research Center at Washington State University, Pullman, WA, USA
| | | | - Florence C Fee
- NHMH - No Health without Mental Health, San Francisco, CA, Arlington, VA, USA
| | | | | | - Bernadette McDonald
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Jeremey Mullins
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Erin Hafer
- Community Health Plan of Washington, Seattle, WA, USA
| | | | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
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Saldana L, Bennett I, Powers D, Vredevoogd M, Grover T, Schaper H, Campbell M. Scaling Implementation of Collaborative Care for Depression: Adaptation of the Stages of Implementation Completion (SIC). ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:188-196. [PMID: 31197625 PMCID: PMC6908762 DOI: 10.1007/s10488-019-00944-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Tools to monitor implementation progress could facilitate scale-up of effective treatments. Most treatment for depression, a common and disabling condition, is provided in primary care settings. Collaborative Care Management (CoCM) is an evidence-based model for treating common mental health conditions, including depression, in this setting; yet, it is not widely implemented. The Stages of Implementation Completion (SIC) was adapted for CoCM and piloted in eight rural primary care clinics serving adults challenged by low-income status. The CoCM-SIC accurately assessed implementation effectiveness and detected site variations in performance, suggesting key implementation activities to aid future scale-ups of CoCM for diverse populations.
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Affiliation(s)
- Lisa Saldana
- Oregon Social Learning Center, 10 Shelton McMurphey Blvd, Eugene, OR, 97401, USA.
| | | | | | | | | | - Holle Schaper
- Oregon Social Learning Center, 10 Shelton McMurphey Blvd, Eugene, OR, 97401, USA
| | - Mark Campbell
- Oregon Social Learning Center, 10 Shelton McMurphey Blvd, Eugene, OR, 97401, USA
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Abstract
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. 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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Impact of Collaborative Care on Absenteeism for Depressed Employees Seen in Primary Care Practices: A Retrospective Cohort Study. J Occup Environ Med 2019; 60:83-89. [PMID: 28961593 DOI: 10.1097/jom.0000000000001173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The impact of "real world" collaborative care on depression and absenteeism for depressed employees seen in primary care practices using objective employer absence data. METHODS A retrospective cohort study comparing depressed employees seen in primary care practices who enrolled for a "real world" collaborative care program to practice as usual (PAU) on objective absence days and depression response and remission at 6, and 12-month time periods. RESULTS Absence days were more in the collaborative care group compared with the PAU group at 3 and 6 months but at 12 months the difference was no longer statistically significant. Collaborative care led to better response and remission depression scores compared with PAU at 12 months. CONCLUSIONS Collaborative care led to faster improvement in depression symptoms but did not translate to less time away from work.
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Leung LB, Rubenstein LV, Yoon J, Post EP, Jaske E, Wells KB, Trivedi RB. Veterans Health Administration Investments In Primary Care And Mental Health Integration Improved Care Access. Health Aff (Millwood) 2019; 38:1281-1288. [DOI: 10.1377/hlthaff.2019.00270] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Lucinda B. Leung
- Lucinda B. Leung is a core investigator in the Veterans Affairs (VA) Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, and an assistant professor of medicine in the Division of General Internal Medicine and Health Services Research at the University of California Los Angeles (UCLA) David Geffen School of Medicine
| | - Lisa V. Rubenstein
- Lisa V. Rubenstein is a professor emerita of medicine in the Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, and the Department of Health Policy and Management, UCLA Fielding School of Public Health
| | - Jean Yoon
- Jean Yoon is a health economist at the Health Economics Resource Center, VA Palo Alto Healthcare System, in Menlo Park, California, and the University of California San Francisco
| | - Edward P. Post
- Edward P. Post is the national Primary Care–Mental Health Integration medical director in the Veterans Health Administration based out of the VA Ann Arbor Healthcare System and a professor of medicine in the Division of General Medicine, University of Michigan, in Ann Arbor
| | - Erin Jaske
- Erin Jaske is a data analyst in the Primary Care Analytics Team, VA Puget Sound Healthcare System, in Seattle, Washington
| | - Kenneth B. Wells
- Kenneth B. Wells is the director of the UCLA Center for Health Services and Society; a professor of psychiatry in the Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior; and an associate investigator at the VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System
| | - Ranak B. Trivedi
- Ranak B. Trivedi is a core investigator at the Center for Innovation to Implementation, VA Palo Alto Healthcare System, and an assistant professor of psychiatry in the Department of Public Mental Health and Population Sciences, Stanford University, in Menlo Park, California
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VitalSign 6: A Primary Care First (PCP-First) Model for Universal Screening and Measurement-Based Care for Depression. Pharmaceuticals (Basel) 2019; 12:ph12020071. [PMID: 31091770 PMCID: PMC6630588 DOI: 10.3390/ph12020071] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/03/2019] [Accepted: 05/08/2019] [Indexed: 12/15/2022] Open
Abstract
Major depressive disorder affects one in five adults in the United States. While practice guidelines recommend universal screening for depression in primary care settings, clinical outcomes suffer in the absence of optimal models to manage those who screen positive for depression. The current practice of employing additional mental health professionals perpetuates the assumption that primary care providers (PCP) cannot effectively manage depression, which is not feasible, due to the added costs and shortage of mental health professionals. We have extended our previous work, which demonstrated similar treatment outcomes for depression in primary care and psychiatric settings, using measurement-based care (MBC) by developing a model, called Primary Care First (PCP-First), that empowers PCPs to effectively manage depression in their patients. This model incorporates health information technology tools, through an electronic health records (EHR) integrated web-application and facilitates the following five components: (1) Screening (2) diagnosis (3) treatment selection (4) treatment implementation and (5) treatment revision. We have implemented this model as part of a quality improvement project, called VitalSign6, and will measure its success using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework. In this report, we provide the background and rationale of the PCP-First model and the operationalization of VitalSign6 project.
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Sunderji N, Ion A, Zhu A, Perivolaris A, Rodie D, Mulsant BH. Challenges in conducting research on collaborative mental health care: a qualitative study. CMAJ Open 2019; 7:E405-E414. [PMID: 31201177 PMCID: PMC6579651 DOI: 10.9778/cmajo.20180172] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND We sought to understand poor uptake of the Primary Care Assessment and Research of a Telephone Intervention for Neuropsychiatric Conditions with Education and Resources study (PARTNERs), a pragmatic randomized controlled trial of a collaborative care intervention for people experiencing depression, anxiety or at-risk drinking. We explored primary care providers' experience with PARTNERs, and preferences regarding collaborative care models and trials. METHODS In this qualitative study, we interviewed primary care providers across Ontario who had participated in PARTNERs, using stratified sampling to reach high-, low- and nonreferring providers in urban and rural settings. We audio-recorded, transcribed and thematically analyzed the interviews between May and December 2017, collecting and analyzing data concurrently until achieving saturation. RESULTS We interviewed 23 primary care providers. They valued the unique availability of telephone-based coaching for patients but desired greater integration of the coach into their practice. They appreciated expert psychiatric recommendations but rarely changed their practices. Sites varied in organizational adoption and implementation of the study, including whether they designated a local champion, proactively identified eligible patients, integrated the study into existing workflows and reflected on (and revised) practices. These behaviours affected continuing awareness of the study and referral rates. INTERPRETATION Study uptake was influenced by the limited relationship between PARTNERs coaches and primary care providers, and variable attention to leadership, training and quality improvement as vital elements of collaborative care. Study designs focusing on implementation could promote reach and penetration of novel interventions in the practice setting and more successfully advance collaborative care implementation.
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Affiliation(s)
- Nadiya Sunderji
- Waypoint Centre for Mental Health Care (Sunderji), Penetanguishene, Ont.; Li Ka Shing Knowledge Institute (Sunderji), St. Michael's Hospital; Department of Psychiatry (Sunderji, Rodie, Mulsant), University of Toronto, Toronto, Ont.; Waypoint Research Institute (Sunderji), Penetanguishene, Ont.; St. Michael's Hospital Mental Health Research Group (Ion), Toronto, Ont.; School of Social Work (Ion), McMaster University, Hamilton, Ont.; Faculty of Medicine (Zhu), University of Toronto; Medical Psychiatry Alliance & Collaborative Care (Perivolaris), Telepsychiatry (Rodie) and Campbell Family Mental Health Research Institute (Mulsant), Centre for Addiction and Mental Health, Toronto, Ont.
| | - Allyson Ion
- Waypoint Centre for Mental Health Care (Sunderji), Penetanguishene, Ont.; Li Ka Shing Knowledge Institute (Sunderji), St. Michael's Hospital; Department of Psychiatry (Sunderji, Rodie, Mulsant), University of Toronto, Toronto, Ont.; Waypoint Research Institute (Sunderji), Penetanguishene, Ont.; St. Michael's Hospital Mental Health Research Group (Ion), Toronto, Ont.; School of Social Work (Ion), McMaster University, Hamilton, Ont.; Faculty of Medicine (Zhu), University of Toronto; Medical Psychiatry Alliance & Collaborative Care (Perivolaris), Telepsychiatry (Rodie) and Campbell Family Mental Health Research Institute (Mulsant), Centre for Addiction and Mental Health, Toronto, Ont
| | - Annie Zhu
- Waypoint Centre for Mental Health Care (Sunderji), Penetanguishene, Ont.; Li Ka Shing Knowledge Institute (Sunderji), St. Michael's Hospital; Department of Psychiatry (Sunderji, Rodie, Mulsant), University of Toronto, Toronto, Ont.; Waypoint Research Institute (Sunderji), Penetanguishene, Ont.; St. Michael's Hospital Mental Health Research Group (Ion), Toronto, Ont.; School of Social Work (Ion), McMaster University, Hamilton, Ont.; Faculty of Medicine (Zhu), University of Toronto; Medical Psychiatry Alliance & Collaborative Care (Perivolaris), Telepsychiatry (Rodie) and Campbell Family Mental Health Research Institute (Mulsant), Centre for Addiction and Mental Health, Toronto, Ont
| | - Athina Perivolaris
- Waypoint Centre for Mental Health Care (Sunderji), Penetanguishene, Ont.; Li Ka Shing Knowledge Institute (Sunderji), St. Michael's Hospital; Department of Psychiatry (Sunderji, Rodie, Mulsant), University of Toronto, Toronto, Ont.; Waypoint Research Institute (Sunderji), Penetanguishene, Ont.; St. Michael's Hospital Mental Health Research Group (Ion), Toronto, Ont.; School of Social Work (Ion), McMaster University, Hamilton, Ont.; Faculty of Medicine (Zhu), University of Toronto; Medical Psychiatry Alliance & Collaborative Care (Perivolaris), Telepsychiatry (Rodie) and Campbell Family Mental Health Research Institute (Mulsant), Centre for Addiction and Mental Health, Toronto, Ont
| | - David Rodie
- Waypoint Centre for Mental Health Care (Sunderji), Penetanguishene, Ont.; Li Ka Shing Knowledge Institute (Sunderji), St. Michael's Hospital; Department of Psychiatry (Sunderji, Rodie, Mulsant), University of Toronto, Toronto, Ont.; Waypoint Research Institute (Sunderji), Penetanguishene, Ont.; St. Michael's Hospital Mental Health Research Group (Ion), Toronto, Ont.; School of Social Work (Ion), McMaster University, Hamilton, Ont.; Faculty of Medicine (Zhu), University of Toronto; Medical Psychiatry Alliance & Collaborative Care (Perivolaris), Telepsychiatry (Rodie) and Campbell Family Mental Health Research Institute (Mulsant), Centre for Addiction and Mental Health, Toronto, Ont
| | - Benoit H Mulsant
- Waypoint Centre for Mental Health Care (Sunderji), Penetanguishene, Ont.; Li Ka Shing Knowledge Institute (Sunderji), St. Michael's Hospital; Department of Psychiatry (Sunderji, Rodie, Mulsant), University of Toronto, Toronto, Ont.; Waypoint Research Institute (Sunderji), Penetanguishene, Ont.; St. Michael's Hospital Mental Health Research Group (Ion), Toronto, Ont.; School of Social Work (Ion), McMaster University, Hamilton, Ont.; Faculty of Medicine (Zhu), University of Toronto; Medical Psychiatry Alliance & Collaborative Care (Perivolaris), Telepsychiatry (Rodie) and Campbell Family Mental Health Research Institute (Mulsant), Centre for Addiction and Mental Health, Toronto, Ont
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Kilbourne AM, Prenovost KM, Liebrecht C, Eisenberg D, Kim HM, Un H, Bauer MS. Randomized Controlled Trial of a Collaborative Care Intervention for Mood Disorders by a National Commercial Health Plan. Psychiatr Serv 2019; 70:219-224. [PMID: 30602344 PMCID: PMC6522242 DOI: 10.1176/appi.ps.201800336] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Few individuals with mood disorders have access to evidence-based collaborative chronic care models (CCMs) because most patients are seen in small-group practices (<20 providers) with limited capacity to deliver CCMs. In this single-blind randomized controlled trial, we determined whether a CCM delivered nationally in a U.S. health plan improved 12-month outcomes among enrollees with mood disorders compared with usual care. METHODS Aetna insurance enrollees (N=238), mostly females (66.1%) with a mean age of 41.1 years, who were recently hospitalized for unipolar major depression or bipolar disorder provided informed consent, completed baseline assessments, and were randomly assigned to usual care or CCM. The CCM included 10 sessions of the Life Goals self-management program and brief contacts by phone by a care manager to determine symptom status. Primary outcomes were changes over 12 months in depression symptoms (nine-item Patient Health Questionnaire [PHQ-9]) and mental health-related quality of life (Short Form-12). RESULTS Adjusted mean PHQ-9 scores were lower by 2.34 points (95% confidence level [CL]=-4.18 to -0.50, p=0.01), indicating improved symptoms, and adjusted mean SF-12 mental health scores were higher by 3.21 points (CL=-.97 to 7.38, p=0.10), indicating better quality of life, among participants receiving CCM versus usual care. CONCLUSIONS Individuals receiving CCM compared with usual care had improved clinical outcomes, although substantial attrition may limit the impact of health plan-level delivery of CCMs. Further research on the use of health plan-level interventions, such as CCMs, as alternatives to practice-based models is warranted.
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Affiliation(s)
- Amy M Kilbourne
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Kilbourne, Kim); Department of Psychiatry, University of Michigan Medical School, North Campus, Ann Arbor (Kilbourne, Prenovost, Liebrecht); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Eisenberg); Aetna Healthcare, Blue Bell, Pennsylvania (Un); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Bauer)
| | - Katherine M Prenovost
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Kilbourne, Kim); Department of Psychiatry, University of Michigan Medical School, North Campus, Ann Arbor (Kilbourne, Prenovost, Liebrecht); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Eisenberg); Aetna Healthcare, Blue Bell, Pennsylvania (Un); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Bauer)
| | - Celeste Liebrecht
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Kilbourne, Kim); Department of Psychiatry, University of Michigan Medical School, North Campus, Ann Arbor (Kilbourne, Prenovost, Liebrecht); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Eisenberg); Aetna Healthcare, Blue Bell, Pennsylvania (Un); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Bauer)
| | - Daniel Eisenberg
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Kilbourne, Kim); Department of Psychiatry, University of Michigan Medical School, North Campus, Ann Arbor (Kilbourne, Prenovost, Liebrecht); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Eisenberg); Aetna Healthcare, Blue Bell, Pennsylvania (Un); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Bauer)
| | - Hyungjin Myra Kim
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Kilbourne, Kim); Department of Psychiatry, University of Michigan Medical School, North Campus, Ann Arbor (Kilbourne, Prenovost, Liebrecht); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Eisenberg); Aetna Healthcare, Blue Bell, Pennsylvania (Un); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Bauer)
| | - Hyong Un
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Kilbourne, Kim); Department of Psychiatry, University of Michigan Medical School, North Campus, Ann Arbor (Kilbourne, Prenovost, Liebrecht); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Eisenberg); Aetna Healthcare, Blue Bell, Pennsylvania (Un); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Bauer)
| | - Mark S Bauer
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Kilbourne, Kim); Department of Psychiatry, University of Michigan Medical School, North Campus, Ann Arbor (Kilbourne, Prenovost, Liebrecht); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Eisenberg); Aetna Healthcare, Blue Bell, Pennsylvania (Un); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Bauer)
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Lahey R, Ewald B, Vail M, Golden R. Identifying and managing depression through collaborative care: expanding social work's impact. SOCIAL WORK IN HEALTH CARE 2019; 58:93-107. [PMID: 30590995 DOI: 10.1080/00981389.2018.1556977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
While behavioral health symptoms commonly present in primary care, most primary care providers lack the time, resources, and expertise to identify and treat them on their own. To address this need, many quality improvement efforts are underway to expand teams and integrate behavioral health assessments and interventions into primary care. Due to their expertise in behavioral health, community supports, and behavioral activation, social workers are natural leaders in integrating care. This paper describes one urban academic medical center's efforts to ensure adolescent and adult patients with depressive symptoms are connected to adequate care and support. A case study is included to demonstrate the Collaborative Care Team model as described, including details regarding the role social workers play. Key quality improvement and policy considerations for scaling up and sustaining collaborative initiative are included.
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Affiliation(s)
- Rebecca Lahey
- a Social work and Community Health , Rush University Medical Center , Chicago , Illinois , USA
| | - Bonnie Ewald
- a Social work and Community Health , Rush University Medical Center , Chicago , Illinois , USA
| | - Matthew Vail
- a Social work and Community Health , Rush University Medical Center , Chicago , Illinois , USA
| | - Robyn Golden
- a Social work and Community Health , Rush University Medical Center , Chicago , Illinois , USA
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24
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Adaji A. Integrated Care: A Disruptive Innovation for Extending Psychiatric Expertise to Primary Care Practices. Mayo Clin Proc Innov Qual Outcomes 2018; 2:99-102. [PMID: 30225439 PMCID: PMC6124336 DOI: 10.1016/j.mayocpiqo.2018.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Akuh Adaji
- Department of Psychiatry and Psychology, Mayo Clinic Health System, Austin, MN; and Division of Integrated Behavioral Health, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
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25
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Ashmore JA, Ditterich KW, Conley CC, Wright MR, Howland PS, Huggins KL, Cooreman J, Andrews PS, Nicholas DR, Roberts L, Hewitt L, Scales JN, Delap JK, Gray CA, Tyler LA, Collins C, Whiting CM, Brothers BM, Ryba MM, Andersen BL. Evaluating the effectiveness and implementation of evidence-based treatment: A multisite hybrid design. ACTA ACUST UNITED AC 2018; 74:459-473. [PMID: 30024215 DOI: 10.1037/amp0000309] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The gap between treatment development and efficacy testing to scaled up implementations of evidence-based treatment (EBT) is an estimated 20 years, and hybrid research designs aim to reduce the gap. One was used for a multisite study in cancer control, testing coprimary aims: (a) determine the feasibility and utility of a flexible EBT implementation strategy and (b) determine the clinical effectiveness of an EBT as implemented by newly trained providers. Therapists from 15 diverse sites implemented the biobehavioral intervention (BBI) for cancer patients (N = 158) as part of standard care. For implementation, therapists determined treatment format, number of sessions, and so forth and reported session-by-session fidelity. Patients completed fidelity and outcome assessments. Results showed therapists BBI implementation was done with fidelity, for example, session "dose" (59%), core content coverage (60-70%), and others. Patient reported fidelity was favorable and comparable to the BBI efficacy trial. Effectiveness data show the primary outcome, patients' scores on the Profile of Mood States total mood disturbance, significantly improved (R² = 0.06, β = -0.24, p < .01) as did a secondary outcome, physical activity (R² = 0.02, β = 0.13, p < .05). This first use of a hybrid design in health psychology provided support for a novel strategy that allowed providers implementation flexibility. Still, the EBT was delivered with fidelity and in addition, therapists generated novel procedures to enhance setting-specific usage of BBI and its ultimate effectiveness with patients. This research is an example of translational research spanning theory and efficacy tests to dissemination and implementation. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | | | | | - Donald R Nicholas
- Department of Counseling Psychology, Social Psychology and Counseling
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26
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Sunderji N, Kurdyak PA, Sockalingam S, Mulsant BH. Can Collaborative Care Cure the Mediocrity of Usual Care for Common Mental Disorders? CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:427-431. [PMID: 29316806 PMCID: PMC6099775 DOI: 10.1177/0706743717748884] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nadiya Sunderji
- 1 Department of Psychiatry, University of Toronto, Ontario.,2 Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario
| | - Paul A Kurdyak
- 1 Department of Psychiatry, University of Toronto, Ontario.,3 Centre for Addiction and Mental Health, Toronto, Ontario
| | - Sanjeev Sockalingam
- 1 Department of Psychiatry, University of Toronto, Ontario.,4 Wilson Centre, University Health Network, Toronto, Ontario
| | - Benoit H Mulsant
- 1 Department of Psychiatry, University of Toronto, Ontario.,3 Centre for Addiction and Mental Health, Toronto, Ontario
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27
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Ben Charif A, Zomahoun HTV, LeBlanc A, Langlois L, Wolfenden L, Yoong SL, Williams CM, Lépine R, Légaré F. Effective strategies for scaling up evidence-based practices in primary care: a systematic review. Implement Sci 2017; 12:139. [PMID: 29166911 PMCID: PMC5700621 DOI: 10.1186/s13012-017-0672-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/13/2017] [Indexed: 01/04/2023] Open
Abstract
Background While an extensive array of existing evidence-based practices (EBPs) have the potential to improve patient outcomes, little is known about how to implement EBPs on a larger scale. Therefore, we sought to identify effective strategies for scaling up EBPs in primary care. Methods We conducted a systematic review with the following inclusion criteria: (i) study design: randomized and non-randomized controlled trials, before-and-after (with/without control), and interrupted time series; (ii) participants: primary care-related units (e.g., clinical sites, patients); (iii) intervention: any strategy used to scale up an EBP; (iv) comparator: no restrictions; and (v) outcomes: no restrictions. We searched MEDLINE, Embase, PsycINFO, Web of Science, CINAHL, and the Cochrane Library from database inception to August 2016 and consulted clinical trial registries and gray literature. Two reviewers independently selected eligible studies, then extracted and analyzed data following the Cochrane methodology. We extracted components of scaling-up strategies and classified them into five categories: infrastructure, policy/regulation, financial, human resources-related, and patient involvement. We extracted scaling-up process outcomes, such as coverage, and provider/patient outcomes. We validated data extraction with study authors. Results We included 14 studies. They were published since 2003 and primarily conducted in low-/middle-income countries (n = 11). Most were funded by governmental organizations (n = 8). The clinical area most represented was infectious diseases (HIV, tuberculosis, and malaria, n = 8), followed by newborn/child care (n = 4), depression (n = 1), and preventing seniors’ falls (n = 1). Study designs were mostly before-and-after (without control, n = 8). The most frequently targeted unit of scaling up was the clinical site (n = 11). The component of a scaling-up strategy most frequently mentioned was human resource-related (n = 12). All studies reported patient/provider outcomes. Three studies reported scaling-up coverage, but no study quantitatively reported achieving a coverage of 80% in combination with a favorable impact. Conclusions We found few studies assessing strategies for scaling up EBPs in primary care settings. It is uncertain whether any strategies were effective as most studies focused more on patient/provider outcomes and less on scaling-up process outcomes. Minimal consensus on the metrics of scaling up are needed for assessing the scaling up of EBPs in primary care. Trial registration This review is registered as PROSPERO CRD42016041461. Electronic supplementary material The online version of this article (10.1186/s13012-017-0672-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ali Ben Charif
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada.,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada.,Centre de recherche sur les soins et les services de première ligne (CERSSPL), Université Laval, Quebec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada.,Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Quebec, QC, Canada
| | - Hervé Tchala Vignon Zomahoun
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada.,Centre de recherche sur les soins et les services de première ligne (CERSSPL), Université Laval, Quebec, QC, Canada
| | - Annie LeBlanc
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada.,Centre de recherche sur les soins et les services de première ligne (CERSSPL), Université Laval, Quebec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada.,Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Quebec, QC, Canada
| | - Léa Langlois
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada.,Centre de recherche sur les soins et les services de première ligne (CERSSPL), Université Laval, Quebec, QC, Canada
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Hunter New England Population Health, Wallsend, NSW, 2287, Australia
| | - Sze Lin Yoong
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Hunter New England Population Health, Wallsend, NSW, 2287, Australia
| | - Christopher M Williams
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Roxanne Lépine
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada.,Centre de recherche sur les soins et les services de première ligne (CERSSPL), Université Laval, Quebec, QC, Canada
| | - France Légaré
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada. .,Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada. .,Centre de recherche sur les soins et les services de première ligne (CERSSPL), Université Laval, Quebec, QC, Canada. .,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada. .,Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Quebec, QC, Canada. .,Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Pavillon Landry-Poulin - 2525 Chemin de la Canardière, Quebec City, QC, G1J 0A4, Canada.
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28
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Menear M, Gilbert M, Fleury MJ. Améliorer la santé mentale des populations par l’intégration des soins de santé mentale aux soins primaires. SANTE MENTALE AU QUEBEC 2017. [DOI: 10.7202/1040253ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
L’intégration des soins de santé mentale dans les soins primaires est une stratégie importante pour améliorer la santé mentale et le bien-être des populations. Dans la dernière décennie, le Québec a adopté plusieurs mesures pour renforcer les soins de santé mentale primaires, mais certains problèmes d’intégration persistent. Cette synthèse a été réalisée afin d’identifier et comparer les grandes initiatives internationales liées à l’intégration des soins de santé mentale aux soins primaires et de résumer les leçons tirées de ces initiatives qui sont pertinentes pour le Québec. Vingt initiatives ont été sélectionnées, décrites dans 153 articles et rapports. Trois initiatives portaient sur la santé mentale des jeunes, quatorze portaient principalement sur les adultes et trois autres initiatives portaient sur la santé mentale des aînés. La majorité des initiatives ont visé à implanter des modèles de soins de collaboration pour améliorer la gestion des troubles mentaux courants par les intervenants en soins primaires. Les initiatives ont été comparées sur les stratégies d’intégration adoptées, leurs effets, et les enjeux d’implantation rencontrés. Les leçons pour le Québec incluent le besoin de consolider davantage les soins en collaboration en santé mentale, de promouvoir des services informés par des processus d’amélioration continue de la qualité et de favoriser une plus grande utilisation des technologies qui soutiennent l’intégration.
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Affiliation(s)
- Matthew Menear
- Ph. D., stagiaire postdoctoral, Département de médecine familiale et médecine d’urgence, Université Laval – Centre de recherche du CHU de Québec – Université Laval
| | - Michel Gilbert
- Ps. Éd., coordonnateur, Centre national d’excellence en santé mentale, Direction de la santé mentale, Ministère de la Santé et des Services sociaux
| | - Marie-Josée Fleury
- Ph. D., professeure agrégée, Département de psychiatrie, Université McGill, Centre de recherche du Douglas Institut universitaire en santé mentale – chercheur senior FRQ-S – directrice scientifique, Centre de réadaptation en dépendance de Montréal – Institut universitaire
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29
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A Statewide Effort to Implement Collaborative Care for Depression: Reach and Impact for All Patients With Depression. Med Care 2017; 54:992-997. [PMID: 27479596 DOI: 10.1097/mlr.0000000000000602] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known about the reach and impact of collaborative care for depression outside of clinical trials. OBJECTIVE The objective of this study was to examine the effect of a collaborative care intervention for depression on the rates of depression diagnosis, use of specific depression codes, and treatment intensification. RESEARCH DESIGN Evaluation of a staggered, multiple baseline implementation initiative. SUBJECTS Patients receiving depression care in primary care clinics throughout Minnesota from February 2008 through March 2011. MEASURES Data regarding depression diagnosis rates and codes, and measures of antidepressant intensification were provided by health insurers. RESULTS Depression Improvement Across Minnesota: Offering a New Direction (DIAMOND) affected neither rates of depression recognition nor use of depression diagnostic codes, and the overall reach of DIAMOND was disappointingly small. Patients in DIAMOND had more episodes of treatment intensification than non-DIAMOND patients, but we were unable to account for depression severity in our analysis. CONCLUSIONS DIAMOND did not affect depression recognition or diagnostic coding, but may have affected treatment intensification. Our results suggest that even strongly evidence-based interventions may have little contamination effects on patients not enrolled in the new care model.
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30
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Smith SM, Cousins G, Clyne B, Allwright S, O'Dowd T. Shared care across the interface between primary and specialty care in management of long term conditions. Cochrane Database Syst Rev 2017; 2:CD004910. [PMID: 28230899 PMCID: PMC6473196 DOI: 10.1002/14651858.cd004910.pub3] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Shared care has been used in the management of many chronic conditions with the assumption that it delivers better care than primary or specialty care alone; however, little is known about the effectiveness of shared care. OBJECTIVES To determine the effectiveness of shared care health service interventions designed to improve the management of chronic disease across the primary/specialty care interface. This is an update of a previously published review.Secondary questions include the following:1. Which shared care interventions or portions of shared care interventions are most effective?2. What do the most effective systems have in common? SEARCH METHODS We searched MEDLINE, Embase and the Cochrane Library to 12 October 2015. SELECTION CRITERIA One review author performed the initial abstract screen; then two review authors independently screened and selected studies for inclusion. We considered randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after studies (CBAs) and interrupted time series analyses (ITS) evaluating the effectiveness of shared care interventions for people with chronic conditions in primary care and community settings. The intervention was compared with usual care in that setting. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from the included studies, evaluated study quality and judged the certainty of the evidence using the GRADE approach. We conducted a meta-analysis of results when possible and carried out a narrative synthesis of the remainder of the results. We presented the results in a 'Summary of findings' table, using a tabular format to show effect sizes for all outcome types. MAIN RESULTS We identified 42 studies of shared care interventions for chronic disease management (N = 18,859), 39 of which were RCTs, two CBAs and one an NRCT. Of these 42 studies, 41 examined complex multi-faceted interventions and lasted from six to 24 months. Overall, our confidence in results regarding the effectiveness of interventions ranged from moderate to high certainty. Results showed probably few or no differences in clinical outcomes overall with a tendency towards improved blood pressure management in the small number of studies on shared care for hypertension, chronic kidney disease and stroke (mean difference (MD) 3.47, 95% confidence interval (CI) 1.68 to 5.25)(based on moderate-certainty evidence). Mental health outcomes improved, particularly in response to depression treatment (risk ratio (RR) 1.40, 95% confidence interval (CI) 1.22 to 1.62; six studies, N = 1708) and recovery from depression (RR 2.59, 95% CI 1.57 to 4.26; 10 studies, N = 4482) in studies examining the 'stepped care' design of shared care interventions (based on high-certainty evidence). Investigators noted modest effects on mean depression scores (standardised mean difference (SMD) -0.29, 95% CI -0.37 to -0.20; six studies, N = 3250). Differences in patient-reported outcome measures (PROMs), processes of care and participation and default rates in shared care services were probably limited (based on moderate-certainty evidence). Studies probably showed little or no difference in hospital admissions, service utilisation and patient health behaviours (with evidence of moderate certainty). AUTHORS' CONCLUSIONS This review suggests that shared care improves depression outcomes and probably has mixed or limited effects on other outcomes. Methodological shortcomings, particularly inadequate length of follow-up, may account in part for these limited effects. Review findings support the growing evidence base for shared care in the management of depression, particularly stepped care models of shared care. Shared care interventions for other conditions should be developed within research settings, with account taken of the complexity of such interventions and awareness of the need to carry out longer studies to test effectiveness and sustainability over time.
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Affiliation(s)
- Susan M Smith
- RCSI Medical SchoolHRB Centre for Primary Care Research, Department of General Practice123 St Stephens GreenDublinIreland
| | - Gráinne Cousins
- Royal College of Surgeons in IrelandSchool of Pharmacy123 St. Stephens GreenDublinIrelandDublin 2
| | - Barbara Clyne
- RCSI Medical SchoolHRB Centre for Primary Care Research, Department of General Practice123 St Stephens GreenDublin 2Ireland
| | - Shane Allwright
- Trinity College Centre for Health SciencesDepartment of Public Health and Primary CareDublinIreland
| | - Tom O'Dowd
- Trinity College Centre for Health SciencesDepartment of Public Health and Primary CareDublinIreland
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31
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Rossom RC, Solberg LI, Magnan S, Crain AL, Beck A, Coleman KJ, Katzelnick D, Williams MD, Neely C, Ohnsorg K, Whitebird R, Brandenfels E, Pollock B, Ferguson R, Williams S, Unützer J. Impact of a national collaborative care initiative for patients with depression and diabetes or cardiovascular disease. Gen Hosp Psychiatry 2017; 44:77-85. [PMID: 27558106 DOI: 10.1016/j.genhosppsych.2016.05.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The spread of evidence-based care is an important challenge in healthcare. We evaluated spread of an evidence-based large-scale multisite collaborative care model for patients with depression and diabetes and/or cardiovascular disease (COMPASS). METHODS Primary care patients with depression and comorbid diabetes or cardiovascular disease were recruited. Collaborative care teams used care management tracking systems and systematic case reviews to track and intensify treatment for patients not improving. Targeted outcomes were depression remission and response (assessed with the Patient Health Questionnaire-9) and control of diabetes (assessed by HbA1c) and blood pressure. Patients and clinicians were surveyed about satisfaction with care. RESULTS Eighteen care systems and 172 clinics enrolled 3609 patients across the US. Of those with uncontrolled disease at enrollment, 40% achieved depression remission or response, 23% glucose control and 58% blood pressure control during a mean follow-up of 11 months. There were large variations in outcomes across medical groups. Patients and clinicians were satisfied with COMPASS care. CONCLUSIONS COMPASS was successfully spread across diverse care systems and demonstrated improved outcomes for complex patients with previously uncontrolled chronic disease. Future large-scale implementation projects should create robust processes to identify and reduce expected variation in implementation to consistently provide improved care.
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Affiliation(s)
- Rebecca C Rossom
- HealthPartners Institute, 8170 33rd Ave. S., MS23301A, Minneapolis, MN 55425.
| | - Leif I Solberg
- HealthPartners Institute, 8170 33rd Ave. S., MS23301A, Minneapolis, MN 55425
| | - Sanne Magnan
- Institute for Clinical Systems Improvement, 8009 34th Ave. S., Suite 1200, Bloomington, MN, 55425-1624
| | - A Lauren Crain
- HealthPartners Institute, 8170 33rd Ave. S., MS23301A, Minneapolis, MN 55425
| | - Arne Beck
- Kaiser Permanente Colorado Institute for Health Research, P.O. Box 378066, Denver, CO, 80237-8066
| | - Karen J Coleman
- Kaiser Permanente Southern California, Department of Research and Evaluation, 100 S. Los Robles Ave., 2nd Floor, Pasadena, CA, 91101-2453
| | - David Katzelnick
- Mayo Clinic, Psychiatry and Psychology Division of Integrated Behavioral Health, 200 First St. SW, Rochester, MN, 55905
| | - Mark D Williams
- Mayo Clinic, Psychiatry and Psychology Division of Integrated Behavioral Health, 200 First St. SW, Rochester, MN, 55905
| | - Claire Neely
- Institute for Clinical Systems Improvement, 8009 34th Ave. S., Suite 1200, Bloomington, MN, 55425-1624
| | - Kris Ohnsorg
- HealthPartners Institute, 8170 33rd Ave. S., MS23301A, Minneapolis, MN 55425
| | - Robin Whitebird
- HealthPartners Institute, 8170 33rd Ave. S., MS23301A, Minneapolis, MN 55425; University of St. Thomas, School of Social Work, 2115 Summit Ave, St. Paul, MN, 55105
| | - Emily Brandenfels
- Community Health Plan of Washington, 720 Olive Way, Suite 300, Seattle, WA, 98101-1830
| | - Betsy Pollock
- Mount Auburn Cambridge Independent Practice Association, 1380 Soldiers Field Rd., Floor 2, Brighton, MA, 02135-1023
| | - Robert Ferguson
- Pittsburgh Regional Health Initiative, 650 Smithfield St., Centre City Tower, Suite 2400, Pittsburgh, PA, 15222-3900
| | - Steve Williams
- Michigan Center for Clinical Systems Improvement, 233 E. Fulton St., Suite 20, Grand Rapids, MI, 49503-3261
| | - Jürgen Unützer
- University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195-6560
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Coleman KJ, Magnan S, Neely C, Solberg L, Beck A, Trevis J, Heim C, Williams M, Katzelnick D, Unützer J, Pollock B, Hafer E, Ferguson R, Williams S. The COMPASS initiative: description of a nationwide collaborative approach to the care of patients with depression and diabetes and/or cardiovascular disease. Gen Hosp Psychiatry 2017; 44:69-76. [PMID: 27558107 DOI: 10.1016/j.genhosppsych.2016.05.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe a national effort to disseminate and implement an evidence-based collaborative care management model for patients with both depression and poorly controlled diabetes and/or cardiovascular disease across multiple, real-world diverse clinical practice sites. METHODS Goals for the initiative were as follows: (1) to improve depression symptoms in 40% of patients, (2) to improve diabetes and hypertension control rates by 20%, (3) to increase provider satisfaction by 20%, (4) to improve patient satisfaction with their care by 20% and (5) to demonstrate cost savings. A Care Management Tracking System was used for collecting clinical care information to create performance measures for quality improvement while also assessing the overall accomplishment of these goals. RESULTS The Care of Mental, Physical and Substance-use Syndromes (COMPASS) initiative spread an evidence-based collaborative care model among 18 medical groups and 172 clinics in eight states. We describe the initiative's evidence-base and methods for others to replicate our work. CONCLUSIONS The COMPASS initiative demonstrated that a diverse set of health care systems and other organizations can work together to rapidly implement an evidence-based care model for complex, hard-to-reach patients. We present this model as an example of how the time gap between research and practice can be reduced on a large scale.
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Affiliation(s)
- Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California (KPSC), 100 S. Los Robles Ave., 2nd Floor, Pasadena, CA 91101-2453, USA.
| | - Sanne Magnan
- Institute for Clinical Systems Improvement (ICSI), 8009 34th Ave. S., Suite 1200, Bloomington, MN 55425-1624, USA
| | - Claire Neely
- Institute for Clinical Systems Improvement (ICSI), 8009 34th Ave. S., Suite 1200, Bloomington, MN 55425-1624, USA
| | - Leif Solberg
- HealthPartners Institute for Education and Research (HPIER), 8170 33rd Ave. S., MS23301A, P.O. Box 1524, Bloomington, MN 55440-1524, USA
| | - Arne Beck
- Institute for Health Research (KPCO), Kaiser Permanente Colorado, P.O. Box 378066, Denver, CO 80237-8066, USA
| | - Jim Trevis
- Institute for Clinical Systems Improvement (ICSI), 8009 34th Ave. S., Suite 1200, Bloomington, MN 55425-1624, USA
| | - Carla Heim
- Institute for Clinical Systems Improvement (ICSI), 8009 34th Ave. S., Suite 1200, Bloomington, MN 55425-1624, USA
| | - Mark Williams
- Mayo Clinic Health System, 200 First St. SW, Rochester, MN 55905, USA
| | - David Katzelnick
- Mayo Clinic Health System, 200 First St. SW, Rochester, MN 55905, USA
| | - Jürgen Unützer
- AIMS Center, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St., Box 356650, Seattle, WA 98195-6560, USA
| | - Betsy Pollock
- AIMS Center, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St., Box 356650, Seattle, WA 98195-6560, USA; Mount Auburn Cambridge IPA (MACIPA), 1380 Soldiers Field Rd., Floor 2, Brighton, MA 02135-1023, USA
| | - Erin Hafer
- Community Health Plan of Washington (CHPW), 720 Olive Way, Suite 300, Seattle, WA 98101-1830, USA
| | - Robert Ferguson
- Pittsburgh Regional Health Initiative (PRHI), 650 Smithfield St., Centre City Tower, Suite 2400, Pittsburgh, PA 15222-3900, USA
| | - Steve Williams
- Michigan Center for Clinical Systems Improvement (Mi-CCSI), 233 E. Fulton St., Suite 20, Grand Rapids, MI 49503-3261, USA
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Rossom RC, Solberg LI, Vazquez-Benitez G, Crain AL, Beck A, Whitebird R, Glasgow RE. The effects of patient-centered depression care on patient satisfaction and depression remission. Fam Pract 2016; 33:649-655. [PMID: 27535330 PMCID: PMC5161489 DOI: 10.1093/fampra/cmw068] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND While health systems are striving for patient-centered care, they have little evidence to guide them on how to engage patients in their care, or how this may affect patient experiences and outcomes. OBJECTIVE To explore which specific patient-centered aspects of care were best associated with depression improvement and care satisfaction. METHODS Design: observational. SETTING 83 primary care clinics across Minnesota. SUBJECTS Primary care patients with new prescriptions for antidepressants for depression were recruited from 2007 to 2009. OUTCOME MEASURES Patients completed phone surveys regarding demographics and self-rated health status and depression severity at baseline and 6 months. Patient centeredness was assessed via a modified version of the Patient Assessment of Chronic Illness Care. Differences in rates of remission and satisfaction between positive and negative responses for each care process were evaluated using chi-square tests. RESULTS At 6 months, 37% of 792 patients ages 18-88 achieved depression remission, and 79% rated their care as good-to-excellent. Soliciting patient preferences for care and questions or concerns, providing treatment plans, utilizing depression scales and asking about suicide risk were patient-centered measures that were positively associated with depression remission in the unadjusted model; these associations were mildly weakened after adjustment for depression severity and health status. Nearly all measures of patient centeredness were positively associated with care ratings. CONCLUSION The patient centeredness of care influences how patients experience and rate their care. This study identified specific actions providers can take to improve patient satisfaction and depression outcomes.
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Affiliation(s)
| | | | | | | | - Arne Beck
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, USA
| | - Robin Whitebird
- School of Social Work, University of St. Thomas, St. Paul, MN, USA
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The association of unipolar depression with thirty-day mortality after hospitalization for infection: A population-based cohort study in Denmark. J Psychosom Res 2016; 89:32-8. [PMID: 27663108 DOI: 10.1016/j.jpsychores.2016.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/04/2016] [Accepted: 08/07/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE While depression is associated with higher risk of death due to chronic medical conditions, it is unknown if depression increases mortality following serious infections. We sought to determine if pre-existing unipolar depression is associated with increased mortality within 30days after hospitalization for a serious infection. METHODS We conducted a population-based cohort study of all adults hospitalized for an infection in Denmark between 2005 and 2013. Pre-existing unipolar depression was ascertained via psychiatrist diagnoses or at least two antidepressant prescription redemptions within a six month period. Our primary outcome was all-cause mortality within 30days after infection-related hospitalization. We also studied death due to infection within 30days after admission. RESULTS We identified 589,688 individuals who had a total of 703,158 hospitalizations for infections. After adjusting for demographics, infectious diagnosis and time since infection, socioeconomic factors and comorbidities, pre-existing unipolar depression was associated with slightly increased risk of all-cause mortality within 30days after infection-related hospitalization (Mortality Rate Ratio [MRR]: 1.07, 95% Confidence Interval [95% CI]: 1.05, 1.09). The association was strongest among persons who initiated antidepressant treatment within one year before the infection (MRR: 1.30, 95% CI: 1.25, 1.35). Pre-existing unipolar depression was associated with increased risk of death due to sepsis (MRR: 1.30, 95% CI: 1.17, 1.44), pneumonia (MRR: 1.23, 95% CI: 1.16, 1.29) and urinary tract infection (MRR: 1.25, 95% CI: 1.08, 1.44) after adjusting for demographics, infectious diagnosis at admission and time since infection. CONCLUSIONS Pre-existing unipolar depression is associated with slightly increased mortality following hospitalization for an infection.
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Kwan BM, Valeras AB, Levey SB, Nease DE, Talen ME. An Evidence Roadmap for Implementation of Integrated Behavioral Health under the Affordable Care Act. AIMS Public Health 2015; 2:691-717. [PMID: 29546130 PMCID: PMC5690436 DOI: 10.3934/publichealth.2015.4.691] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 10/14/2015] [Indexed: 01/18/2023] Open
Abstract
The Affordable Care Act (ACA) created incentives and opportunities to redesign health care to better address mental and behavioral health needs. The integration of behavioral health and primary care is increasingly viewed as an answer to address such needs, and it is advisable that evidence-based models and interventions be implemented whenever possible with fidelity. At the same time, there are few evidence-based models, especially beyond depression and anxiety, and thus further research and evaluation is needed. Resources being allocated to adoption of models of integrated behavioral health care (IBHC) should include quality improvement, evaluation, and translational research efforts using mixed methodology to enhance the evidence base for IBHC in the context of health care reform. This paper covers six key aspects of the evidence for IBHC, consistent with mental and behavioral health elements of the ACA related to infrastructure, payments, and workforce. The evidence for major IBHC models is summarized, as well as evidence for targeted populations and conditions, education and training, information technology, implementation, and cost and sustainability.
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Affiliation(s)
- Bethany M Kwan
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Aimee B Valeras
- NH Dartmouth Family Medicine Residency, Concord Hospital Family Health Center, Concord, NH, United States
| | - Shandra Brown Levey
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Donald E Nease
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Mary E Talen
- Northwestern Family Medicine Residency, Northwestern McGaw Medical Center and University, Chicago, IL, United States
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