Population-based care of depression: team care approaches to improving outcomes.

OBJECTIVE: To describe evidence-based quality improvement interventions in the primary care system that have been shown in randomized trials to the improve quality of care and outcomes of patients with depression.
METHODS: Medical literature review, focused on the concept of population-based care and research-proven ways to decrease the prevalence of depression in primary care, including several meta-analyses that described the effect of collaborative care interventions in improving the quality and outcomes of primary care patients with depression.
RESULTS: A total of 37 randomized trials of collaborative care interventions have shown that collaborative care, compared with usual primary care, is associated with 2-fold increases in antidepressant adherence, improvements in depressive outcomes that last up to 2 to 5 years, increased patient satisfaction with depression care, and improved primary care satisfaction with treating depression. From a health plan perspective, cost-effectiveness analyses suggest that for most depressed primary care patients, collaborative care is associated with a modest increase in medical costs, but markedly improved depression and functional outcomes. The few studies that have used a societal perspective that included examination of both direct and indirect costs found that collaborative care was associated with overall cost savings. For patients with depression and diabetes and depression and panic disorder, there is evidence that the increase in mental health care costs associated with collaborative care is offset by greater savings in medical costs.
CONCLUSION: Collaborative care is a high value intervention associated with improved quality of care, depression outcomes, and improved patient and primary care physician satisfaction.