Primary care mental health integration to improve early treatment engagement for veterans who screen positive for depression

Objective To examine the relationship between the penetration (or reach) of a national program aiming to integrate mental health clinicians into all primary care clinics (PC‐MHI) and rates of guideline‐concordant follow‐up and treatment among clinic patients newly identified with depression in the Veterans Health Administration (VA). Data Sources/Study Setting 15,155 screen‐positive patients 607,730 patients with 2‐item Patient Health Questionnaire scores in 82 primary care clinics, 2015–2019. Study Design In this retrospective cohort study, we used established depression care quality measures to assess primary care patients who (a) newly screened positive (score ≥3) and (b) were identified with depression by clinicians via diagnosis and/or medication (n = 15,155; 15,650 patient‐years). Timely follow‐up included ≥3 mental health, ≥3 psychotherapy, or ≥3 primary care visits for depression. Minimally appropriate treatment included ≥4 mental health visits, ≥3 psychotherapy, or ≥60 days of medication. In multivariate regressions, we examined whether higher rates of PC‐MHI penetration in clinic (proportion of total primary care patients in a clinic who saw any PC‐MHI clinician) were associated with greater depression care quality among cohort patients, adjusting for year, healthcare system, and patient and clinic characteristics. Data Collection/Extraction Methods Electronic health record data from 82 VA clinics across three states. Principal Findings A median of 9% of all primary care patients were seen by any PC‐MHI clinician annually. In fully adjusted models, greater PC‐MHI penetration was associated with timely depression follow‐up within 84 days (∆P = 0.5; SE = 0.1; p