Effectiveness of collaborative care depression treatment in veterans’ affairs primary care
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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.
This report presents the findings and conclusions of the authors. It does not necessarily represent those of the VA or HSR&D Service.
The Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service supported this research.
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- Effectiveness of collaborative care depression treatment in veterans’ affairs primary care
Journal of General Internal Medicine
Volume 18, Issue 1 , pp 9-16
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- depressive disorder
- primary health care
- Industry Sectors
- Dr. Susan C. Hedrick PhD (1) (2)
- Edmund F. Chaney PhD (4) (5)
- Bradford Felker MD (4) (5)
- Chuan-Fen Liu PhD (1) (2)
- Nicole Hasenberg MPH (2)
- Patrick Heagerty PhD (6)
- Jan Buchanan MSW, MC (7)
- Rocco Bagala ACSW (7)
- Diane Greenberg PhD (4) (5)
- Grady Paden MD (8)
- Stephan D. Fihn MD, MPH (1) (2) (8)
- Wayne Katon MD (5)
- Author Affiliations
- 1. the Health Services Research and Development Center of Excellence, the VA Puget Sound Health Care System, Seattle, Wash
- 2. the Department of Health Services, University of Washington, Seattle, Wash
- 4. Mental Health Service, the VA Puget Sound Health Care System, Seattle, Wash
- 5. the Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Wash
- 6. the Department of Biostatistics, University of Washington, Seattle, Wash
- 7. Social Work, VA Puget Sound and the School of Social Work, University of Washington, Seattle, Wash
- 8. Medical Service, VA Puget Sound and the Department of Medicine, University of Washington, Seattle, Wash