Mental Health and Primary Care Collaboration for Depression Care

2010 ◽  
Author(s):  
Vikram Kambampati
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Depression Care

scholarly journals Primary Care–Mental Health Integration in the VA Health System: Associations Between Provider Staffing and Quality of Depression Care

2017 ◽  
Vol 68 (5) ◽  
pp. 476-481 ◽  
Author(s):  
Debra S. Levine ◽  
John F. McCarthy ◽  
Brittany Cornwell ◽  
Laurie Brockmann ◽  
Paul N. Pfeiffer
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health System ◽  
Depression Care ◽  
Primary Care Mental Health ◽  
Mental Health Integration

scholarly journals Collaborative care clinician perceptions of computerized cognitive behavioral therapy for depression in primary care

2020 ◽  
Vol 10 (3) ◽  
pp. 565-572
Author(s):  
Lucinda B Leung ◽  
Karen E Dyer ◽  
Elizabeth M Yano ◽  
Alexander S Young ◽  
Lisa V Rubenstein ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Cognitive Behavioral Therapy ◽  
Collaborative Care ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Mental Health Clinicians ◽  
Depression Care ◽  
Care Managers ◽  
Primary Care Patients

Abstract In Veterans Health Administration’s (VA) Primary Care–Mental Health Integration (PC-MHI) models, primary care providers, care managers, and mental health clinicians collaboratively provide depression care. Primary care patients, however, still lack timely, sufficient access to psychotherapy treatment. Adapting PC-MHI collaborative care to improve uptake of evidence-based computerized cognitive behavioral therapy (cCBT) may be a potential solution. Understanding primary care-based mental health clinician perspectives is crucial for facilitating adoption of cCBT as part of collaborative depression care. We examined PC-MHI mental health clinicians’ perspectives on adapting collaborative care models to support cCBT for VA primary care patients. We conducted 16 semi-structured interviews with PC-MHI nurse care managers, licensed social workers, psychologists, and psychiatrists in one VA health-care system. Interviews were audio-recorded, transcribed, coded using the constant comparative method, and analyzed for overarching themes. Although cCBT awareness and knowledge were not widespread, participants were highly accepting of enhancing PC-MHI models with cCBT for depression treatment. Participants supported cCBT delivery by a PC-MHI care manager or clinician and saw it as an additional tool to engage patients, particularly younger Veterans, in mental health treatment. They commented that current VA PC-MHI models did not facilitate, and had barriers to, use of online and mobile treatments. If effectively implemented, however, respondents thought it had potential to increase the number of patients they could treat. There is widespread interest in modernizing health systems. VA PC-MHI mental health clinicians appear open to adapting collaborative care to increase uptake of cCBT to improve psychotherapy access.

Process mapping appointments to identify improvements in care delivered to patients who screen positive for depression

2016 ◽  
Vol 4 (3) ◽  
pp. 433
Author(s):  
Bo Kim ◽  
Stephanie Rodrigues ◽  
Natalie S Dell ◽  
Rani Elwy
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Treatment ◽  
Veterans Health ◽  
Health Administration ◽  
Depression Care ◽  
Positive Screen ◽  
Novel Approach ◽  
Using Data

Rationale, aims and objectives  After screening positive for depression, many patients do not receive effective medication or maintain optimal contact with practitioners.  Our objective was to examine how appointments that patients have after screening positive may affect the delivery of evidence-based and guideline-concordant depression care. Methods  We reviewed treatment records for 271 patients who screened positive for depression in primary care across three United States Veterans Health Administration medical facilities.  For each patient, we mapped the process of appointments that took place following the positive screen, noting the number of appointments, the service line in which each appointment was held, as well as whether guideline-concordant depression care was in turn received over four months. Results  We found that (i) approximately half of the patients who screened positive had no follow-up appointments, (ii) all patients who had two or more follow-up appointments received some – but not necessarily guideline-concordant – mental health treatment, and (iii) there were distinct patterns across the three facilities regarding which service lines’ appointments most often resulted in treatment. Conclusions  Our work offers a novel approach of using data on appointments that patients have after screening positive for depression to shed light on current care practices.  The number of post-screening appointments can be an informative process measure for improving depression care to become more guideline-concordant.  Facilities vary substantially in terms of which service lines they use to attain guideline-concordance, likely due to notable differences in how their primary care, integrated primary care behavioral health, and mental health services are organized.

scholarly journals Remote Collaborative Depression Care Program for Adolescents in Araucan�a Region, Chile: Randomized Controlled Trial (Preprint)

2017 ◽  
Author(s):  
Vania Martínez ◽  
Graciela Rojas ◽  
Pablo Martínez ◽  
Pedro Zitko ◽  
Matías Irarrázaval ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Depressive Symptoms ◽  
Clinical Guidelines ◽  
Intervention Group ◽  
Depression Care ◽  
Primary Care Teams ◽  
Primary Care Clinicians ◽  
Specialized Mental Health

BACKGROUND Despite evidence on efficacious interventions, a great proportion of depressed adolescents do not receive evidence-based treatment and have no access to specialized mental health care. Remote collaborative depression care (RCDC) may help to reduce the gap between needs and specialized mental health services. OBJECTIVE The objective of this study was to assess the feasibility, acceptability, and effectiveness of an RCDC intervention for adolescents with major depressive disorder (MDD) living in the Araucanía Region, Chile. METHODS A cluster randomized, assessor-blind trial was carried out at 16 primary care centers in the Araucanía Region, Chile. Before randomization, all participating primary care teams were trained in clinical guidelines for the treatment of adolescent depression. Adolescents (N=143; 13-19 years) with MDD were recruited. The intervention group (RCDC, N=65) received a 3-month RCDC treatment that included continuous remote supervision by psychiatrists located in Santiago, Chile’s capital city, through shared electronic health records (SEHR) and phone patient monitoring. The control group (enhanced usual care or EUC; N=78) received EUC by clinicians who were encouraged to follow clinical guidelines. Recruitment and response rates and the use of the SEHR system were registered; patient adherence and satisfaction with the treatment and clinician satisfaction with RCDC were assessed at 12-week follow-up; and depressive symptoms and health-related quality of life (HRQoL) were evaluated at baseline and 12-weeks follow-up. RESULTS More than 60.3% (143/237) of the original estimated sample size was recruited, and a response rate of 90.9% (130/143) was achieved at 12-week follow-up. A mean (SD) of 3.5 (4.0) messages per patient were written on the SEHR system by primary care teams. A third of the patients showed an optimal adherence to psychopharmacological treatment, and adolescents in the RCDC intervention group were more satisfied with psychological assistance than those in EUC group. Primary care clinicians were satisfied with the RCDC intervention, valuing its usefulness. There were no significant differences in depressive symptoms or HRQoL between groups. Satisfaction with psychological care, in both groups, was related to a significant change in depressive symptomatology at 12-weeks follow-up (beta=−4.3, 95% CI −7.2 to −1.3). CONCLUSIONS This is the first trial of its kind in Latin America that includes adolescents from vulnerable backgrounds, with an intervention that proved to be feasible and well accepted by both patients and primary care clinicians. Design and implementation issues may explain similar effectiveness across arms. The effectiveness of the intervention seems to be comparable with an already nationwide established treatment program that proved to be highly efficacious under controlled conditions. CLINICALTRIAL ClinicalTrials.gov: NCT01860443; https://clinicaltrials.gov/ct2/show/NCT01860443 (Archived by WebCite at http://www.webcitation.org/6wafMKlTY)

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