OBJECTIVE: Depression is commonly seen, but infrequently adequately treated, in primary care clinics. Improving access to depression care in primary care clinics has improved outcomes in clinical trials; however, these interventions are largely unstudied in clinical settings. This study examined the effectiveness of a quality improvement project improving access to mental healthcare in a large primary care clinic. METHODS: A before-after study evaluating the efficacy of the integration of a primary mental healthcare (PMHC) clinic into a large primary care clinic at the White River Junction, Vermont Veterans Affairs Medical Center (VAMC). In the before period (2003), a traditional referral and schedule model was used to access mental healthcare services. Patients who had screened positive for depression using a depression screen for 6 months after entry into either model were retrospectively followed. VA clinics without a PMHC were used as a control. The proportion of patients who received any depression treatment and guideline-adhering depression treatment in each model was compared, as well as the volume of patients seen in mental health clinics and the wait time to be seen by mental health personnel. RESULTS: 383 and 287 patients screened positive for depression at VAMC and the community-based outreach clinic, respectively. Demographics of the before and after cohorts did not differ. The PMHC model was associated with a greater proportion of patients who had screened positive for depression obtaining some depression treatment (52.3% vs 37.8%; p<0.001), an increase in guideline-adherent depression treatment for depression (11% vs 1%; p<0.001). CONCLUSIONS: Implementation of the PMHC model was associated with more rapid and improved treatment for depression in the population of patients who screened positive for depression. More widespread implementation of this model should be investigated.
OBJECTIVE:Depression is commonly seen, but infrequently adequately treated, in primary care clinics. Improving access to depression care in primary care clinics has improved outcomes in clinical trials; however, these interventions are largely unstudied in clinical settings. This study examined the effectiveness of a quality improvement project improving access to mental healthcare in a large primary care clinic. METHODS: A before-after study evaluating the efficacy of the integration of a primary mental healthcare (PMHC) clinic into a large primary care clinic at the White River Junction, Vermont Veterans Affairs Medical Center (VAMC). In the before period (2003), a traditional referral and schedule model was used to access mental healthcare services. Patients who had screened positive for depression using a depression screen for 6 months after entry into either model were retrospectively followed. VA clinics without a PMHC were used as a control. The proportion of patients who received any depression treatment and guideline-adhering depression treatment in each model was compared, as well as the volume of patients seen in mental health clinics and the wait time to be seen by mental health personnel. RESULTS: 383 and 287 patients screened positive for depression at VAMC and the community-based outreach clinic, respectively. Demographics of the before and after cohorts did not differ. The PMHC model was associated with a greater proportion of patients who had screened positive for depression obtaining some depression treatment (52.3% vs 37.8%; p<0.001), an increase in guideline-adherent depression treatment for depression (11% vs 1%; p<0.001). CONCLUSIONS: Implementation of the PMHC model was associated with more rapid and improved treatment for depression in the population of patients who screened positive for depression. More widespread implementation of this model should be investigated.
Authors: Jürgen Unützer; Wayne Katon; Christopher M Callahan; John W Williams; Enid Hunkeler; Linda Harpole; Marc Hoffing; Richard D Della Penna; Polly Hitchcock Noël; Elizabeth H B Lin; Patricia A Areán; Mark T Hegel; Lingqi Tang; Thomas R Belin; Sabine Oishi; Christopher Langston Journal: JAMA Date: 2002-12-11 Impact factor: 56.272
Authors: R L Spitzer; J B Williams; K Kroenke; M Linzer; F V deGruy; S R Hahn; D Brody; J G Johnson Journal: JAMA Date: 1994-12-14 Impact factor: 56.272
Authors: H C Schulberg; M R Block; M J Madonia; C P Scott; E Rodriguez; S D Imber; J Perel; J Lave; P R Houck; J L Coulehan Journal: Arch Gen Psychiatry Date: 1996-10
Authors: Stephen J Bartels; Eugenie H Coakley; Cynthia Zubritsky; James H Ware; Keith M Miles; Patricia A Areán; Hongtu Chen; David W Oslin; Maria D Llorente; Giuseppe Costantino; Louise Quijano; Jack S McIntyre; Karen W Linkins; Thomas E Oxman; James Maxwell; Sue E Levkoff Journal: Am J Psychiatry Date: 2004-08 Impact factor: 18.112
Authors: Evelyn T Chang; Jennifer L Magnabosco; Edmund Chaney; Andrew Lanto; Barbara Simon; Elizabeth M Yano; Lisa V Rubenstein Journal: J Gen Intern Med Date: 2014-02-25 Impact factor: 5.128
Authors: Marisa Sklar; Gregory A Aarons; Maria O'Connell; Larry Davidson; Erik J Groessl Journal: Am J Public Health Date: 2015-07-16 Impact factor: 9.308
Authors: Evelyn T Chang; Danielle E Rose; Elizabeth M Yano; Kenneth B Wells; Maureen E Metzger; Edward P Post; Martin L Lee; Lisa V Rubenstein Journal: J Gen Intern Med Date: 2012-10-05 Impact factor: 5.128
Authors: Rifat Atun; Thyra E de Jongh; Federica V Secci; Kelechi Ohiri; Olusoji Adeyi; Josip Car Journal: BMC Public Health Date: 2011-10-10 Impact factor: 3.295
Authors: G Ogrinc; S E Mooney; C Estrada; T Foster; D Goldmann; L W Hall; M M Huizinga; S K Liu; P Mills; J Neily; W Nelson; P J Pronovost; L Provost; L V Rubenstein; T Speroff; M Splaine; R Thomson; A M Tomolo; B Watts Journal: Qual Saf Health Care Date: 2008-10