Effectiveness of Collaborative Care Depression Treatment in Veterans' Affairs Primary Care

OBJECTIVE: To compare collaborative care for treatment of depression in primary care with consult‐liaison (CL) care. In collaborative care, a mental health team provided a treatment plan to the primary care provider, telephoned patients to support adherence to the plan, reviewed treatment results, a...

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Veröffentlicht in:Journal of general internal medicine : JGIM 2003-01, Vol.18 (1), p.9-16
Hauptverfasser: Hedrick, Susan C., Chaney, Edmund F., Felker, Bradford, Liu, Chuan‐Fen, Hasenberg, Nicole, Heagerty, Patrick, Buchanan, Jan, Bagala, Rocco, Greenberg, Diane, Paden, Grady, Fihn, Stephan D., Katon, Wayne
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container_issue 1
container_start_page 9
container_title Journal of general internal medicine : JGIM
container_volume 18
creator Hedrick, Susan C.
Chaney, Edmund F.
Felker, Bradford
Liu, Chuan‐Fen
Hasenberg, Nicole
Heagerty, Patrick
Buchanan, Jan
Bagala, Rocco
Greenberg, Diane
Paden, Grady
Fihn, Stephan D.
Katon, Wayne
description OBJECTIVE: To compare collaborative care for treatment of depression in primary care with consult‐liaison (CL) care. In collaborative care, a mental health team provided a treatment plan to the primary care provider, telephoned patients to support adherence to the plan, reviewed treatment results, and suggested modifications to the provider. In CL care, study clinicians informed the primary care provider of the diagnosis and facilitated referrals to psychiatry residents practicing in the primary care clinic. DESIGN: Patients were randomly assigned to treatment model by clinic firm. SETTING: VA primary care clinic. PARTICIPANTS: One hundred sixty‐eight collaborative care and 186 CL patients who met criteria for major depression and/or dysthymia. MEASUREMENTS: Hopkins Symptom Checklist (SCL‐20), Short Form (SF)‐36, Sheehan Disability Scale. MAIN RESULTS: Collaborative care produced greater improvement than CL in depressive symptomatology from baseline to 3 months (SCL‐20 change scores), but at 9 months there was no significant difference. The intervention increased the proportion of patients receiving prescriptions and cognitive behavioral therapy. Collaborative care produced significantly greater improvement on the Sheehan at 3 months. A greater proportion of collaborative care patients exhibited an improvement in SF‐36 Mental Component Score of 5 points or more from baseline to 9 months. CONCLUSIONS: Collaborative care resulted in more rapid improvement in depression symptomatology, and a more rapid and sustained improvement in mental health status compared to the more standard model. Mounting evidence indicates that collaboration between primary care providers and mental health specialists can improve depression treatment and supports the necessary changes in clinic structure and incentives.
doi_str_mv 10.1046/j.1525-1497.2003.11109.x
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In collaborative care, a mental health team provided a treatment plan to the primary care provider, telephoned patients to support adherence to the plan, reviewed treatment results, and suggested modifications to the provider. In CL care, study clinicians informed the primary care provider of the diagnosis and facilitated referrals to psychiatry residents practicing in the primary care clinic. DESIGN: Patients were randomly assigned to treatment model by clinic firm. SETTING: VA primary care clinic. PARTICIPANTS: One hundred sixty‐eight collaborative care and 186 CL patients who met criteria for major depression and/or dysthymia. MEASUREMENTS: Hopkins Symptom Checklist (SCL‐20), Short Form (SF)‐36, Sheehan Disability Scale. MAIN RESULTS: Collaborative care produced greater improvement than CL in depressive symptomatology from baseline to 3 months (SCL‐20 change scores), but at 9 months there was no significant difference. The intervention increased the proportion of patients receiving prescriptions and cognitive behavioral therapy. Collaborative care produced significantly greater improvement on the Sheehan at 3 months. A greater proportion of collaborative care patients exhibited an improvement in SF‐36 Mental Component Score of 5 points or more from baseline to 9 months. CONCLUSIONS: Collaborative care resulted in more rapid improvement in depression symptomatology, and a more rapid and sustained improvement in mental health status compared to the more standard model. Mounting evidence indicates that collaboration between primary care providers and mental health specialists can improve depression treatment and supports the necessary changes in clinic structure and incentives.</description><identifier>ISSN: 0884-8734</identifier><identifier>EISSN: 1525-1497</identifier><identifier>DOI: 10.1046/j.1525-1497.2003.11109.x</identifier><identifier>PMID: 12534758</identifier><language>eng</language><publisher>Boston, MA, USA: Blackwell Science Inc</publisher><subject><![CDATA[Adult ; Adult and adolescent clinical studies ; Aged ; Biological and medical sciences ; Cognitive ability ; Collaboration ; Depression ; Depression - therapy ; depressive disorder ; Female ; Health care ; Health Status ; Humans ; Incentives ; Internal medicine ; Internship and Residency ; Male ; Medical sciences ; Mental depression ; Mental health ; Mental Health Services - organization & administration ; Mental Health Services - statistics & numerical data ; Middle Aged ; Models, Organizational ; Mood disorders ; Original ; Patient Care Team - organization & administration ; Patient Care Team - statistics & numerical data ; Patients ; Primary care ; primary health care ; Primary Health Care - organization & administration ; Psychiatry ; Psychiatry - education ; Psychiatry - organization & administration ; Psychology. 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Psychiatry ; Referral and Consultation - organization & administration ; United States ; United States Department of Veterans Affairs - organization & administration ; Veterans]]></subject><ispartof>Journal of general internal medicine : JGIM, 2003-01, Vol.18 (1), p.9-16</ispartof><rights>2003 INIST-CNRS</rights><rights>Society of General Internal Medicine 2003.</rights><rights>2003 by the Society of General Internal Medicine 2003</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5309-d26f40bbdd48ba3a1595dadefdfb9725f852de984d47c6167a6b2c7ffd140e5c3</citedby><cites>FETCH-LOGICAL-c5309-d26f40bbdd48ba3a1595dadefdfb9725f852de984d47c6167a6b2c7ffd140e5c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1494801/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1494801/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,1417,4024,27923,27924,27925,45574,45575,53791,53793</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=14944812$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12534758$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hedrick, Susan C.</creatorcontrib><creatorcontrib>Chaney, Edmund F.</creatorcontrib><creatorcontrib>Felker, Bradford</creatorcontrib><creatorcontrib>Liu, Chuan‐Fen</creatorcontrib><creatorcontrib>Hasenberg, Nicole</creatorcontrib><creatorcontrib>Heagerty, Patrick</creatorcontrib><creatorcontrib>Buchanan, Jan</creatorcontrib><creatorcontrib>Bagala, Rocco</creatorcontrib><creatorcontrib>Greenberg, Diane</creatorcontrib><creatorcontrib>Paden, Grady</creatorcontrib><creatorcontrib>Fihn, Stephan D.</creatorcontrib><creatorcontrib>Katon, Wayne</creatorcontrib><title>Effectiveness of Collaborative Care Depression Treatment in Veterans' Affairs Primary Care</title><title>Journal of general internal medicine : JGIM</title><addtitle>J Gen Intern Med</addtitle><description>OBJECTIVE: To compare collaborative care for treatment of depression in primary care with consult‐liaison (CL) care. In collaborative care, a mental health team provided a treatment plan to the primary care provider, telephoned patients to support adherence to the plan, reviewed treatment results, and suggested modifications to the provider. In CL care, study clinicians informed the primary care provider of the diagnosis and facilitated referrals to psychiatry residents practicing in the primary care clinic. DESIGN: Patients were randomly assigned to treatment model by clinic firm. SETTING: VA primary care clinic. PARTICIPANTS: One hundred sixty‐eight collaborative care and 186 CL patients who met criteria for major depression and/or dysthymia. MEASUREMENTS: Hopkins Symptom Checklist (SCL‐20), Short Form (SF)‐36, Sheehan Disability Scale. MAIN RESULTS: Collaborative care produced greater improvement than CL in depressive symptomatology from baseline to 3 months (SCL‐20 change scores), but at 9 months there was no significant difference. The intervention increased the proportion of patients receiving prescriptions and cognitive behavioral therapy. Collaborative care produced significantly greater improvement on the Sheehan at 3 months. A greater proportion of collaborative care patients exhibited an improvement in SF‐36 Mental Component Score of 5 points or more from baseline to 9 months. CONCLUSIONS: Collaborative care resulted in more rapid improvement in depression symptomatology, and a more rapid and sustained improvement in mental health status compared to the more standard model. Mounting evidence indicates that collaboration between primary care providers and mental health specialists can improve depression treatment and supports the necessary changes in clinic structure and incentives.</description><subject>Adult</subject><subject>Adult and adolescent clinical studies</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cognitive ability</subject><subject>Collaboration</subject><subject>Depression</subject><subject>Depression - therapy</subject><subject>depressive disorder</subject><subject>Female</subject><subject>Health care</subject><subject>Health Status</subject><subject>Humans</subject><subject>Incentives</subject><subject>Internal medicine</subject><subject>Internship and Residency</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mental depression</subject><subject>Mental health</subject><subject>Mental Health Services - organization &amp; administration</subject><subject>Mental Health Services - statistics &amp; numerical data</subject><subject>Middle Aged</subject><subject>Models, Organizational</subject><subject>Mood disorders</subject><subject>Original</subject><subject>Patient Care Team - organization &amp; administration</subject><subject>Patient Care Team - statistics &amp; numerical data</subject><subject>Patients</subject><subject>Primary care</subject><subject>primary health care</subject><subject>Primary Health Care - organization &amp; administration</subject><subject>Psychiatry</subject><subject>Psychiatry - education</subject><subject>Psychiatry - organization &amp; administration</subject><subject>Psychology. 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The intervention increased the proportion of patients receiving prescriptions and cognitive behavioral therapy. Collaborative care produced significantly greater improvement on the Sheehan at 3 months. A greater proportion of collaborative care patients exhibited an improvement in SF‐36 Mental Component Score of 5 points or more from baseline to 9 months. CONCLUSIONS: Collaborative care resulted in more rapid improvement in depression symptomatology, and a more rapid and sustained improvement in mental health status compared to the more standard model. Mounting evidence indicates that collaboration between primary care providers and mental health specialists can improve depression treatment and supports the necessary changes in clinic structure and incentives.</abstract><cop>Boston, MA, USA</cop><pub>Blackwell Science Inc</pub><pmid>12534758</pmid><doi>10.1046/j.1525-1497.2003.11109.x</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record>
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subjects Adult
Adult and adolescent clinical studies
Aged
Biological and medical sciences
Cognitive ability
Collaboration
Depression
Depression - therapy
depressive disorder
Female
Health care
Health Status
Humans
Incentives
Internal medicine
Internship and Residency
Male
Medical sciences
Mental depression
Mental health
Mental Health Services - organization & administration
Mental Health Services - statistics & numerical data
Middle Aged
Models, Organizational
Mood disorders
Original
Patient Care Team - organization & administration
Patient Care Team - statistics & numerical data
Patients
Primary care
primary health care
Primary Health Care - organization & administration
Psychiatry
Psychiatry - education
Psychiatry - organization & administration
Psychology. Psychoanalysis. Psychiatry
Psychopathology. Psychiatry
Referral and Consultation - organization & administration
United States
United States Department of Veterans Affairs - organization & administration
Veterans
title Effectiveness of Collaborative Care Depression Treatment in Veterans' Affairs Primary Care
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