Integrated Care: Treatment Initiation Following Positive Depression Screens

Department of Chronic Disease Epidemiology, Yale School of Public Heath, 60 College Street, P.O. Box 208034, New Haven, CT, 06520-8034, USA, .
Journal of General Internal Medicine (Impact Factor: 3.42). 11/2012; 28(3). DOI: 10.1007/s11606-012-2218-y
Source: PubMed

ABSTRACT BACKGROUND: Primary Care-Mental Health Integration (PC-MHI) may improve mental health services access and continuity of care. OBJECTIVE: To assess whether receipt of integrated PC-MHI services on the date of an initial positive depression screen influences receipt of depression treatment among primary care (PC) patients in the Veterans Health Administration. DESIGN: Retrospective cohort study. SUBJECTS: Thirty-six thousand, two hundred and sixty-three PC patients with positive depression screens between October 1, 2009 and September 30, 2010. MAIN MEASURES: Subjects were assessed for depression diagnosis and initiation of antidepressants or psychotherapy on the screening day, within 12 weeks, and within 6 months. Among individuals with PC encounters on the screening day, setting of services received that day was categorized as PC only, PC-MHI, or Specialty Mental Health (SMH). Using multivariable generalized estimating equations (GEE) logistic regression, we assessed likelihood of treatment initiation, adjusting for demographic and clinical measures, including depression screening score. KEY RESULTS: Patients who received same-day PC-MHI services were more likely to initiate psychotherapy (OR: 8.16; 95 % CI: 6.54-10.17) and antidepressant medications (OR: 2.33, 95 % CI: 2.10-2.58) within 12 weeks than were those who received only PC services on the screening day. CONCLUSIONS: Receipt of same-day PC-MHI may facilitate timely receipt of depression treatment.

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    Journal of General Internal Medicine 11/2012; 28(3). DOI:10.1007/s11606-012-2266-3 · 3.42 Impact Factor
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    Journal of General Internal Medicine 01/2013; 28(3). DOI:10.1007/s11606-012-2330-z · 3.42 Impact Factor
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    ABSTRACT: To examine the impact of Veterans' coping strategies on mental health treatment engagement following a positive screen for depression. A mixed-methods observational study using a mailed survey and semi-structured interviews. Sample included 271 Veterans who screened positive for depression during a primary care visit at one of three VA medical centers and had not received a diagnosis of depression or prescribed antidepressants 12 months prior to screening. A subsample of 23 Veterans was interviewed. Logistic regression models showed that Veterans who reported more instrumental support and active coping were more likely to receive depression or other mental health treatment within three months of their positive depression screen. Those who reported emotional support or self-distraction as coping strategies were less likely to receive any treatment in the same time frame. Qualitative analyses revealed that how Veterans use these and other coping strategies can impact treatment engagement in a variety of ways. The relationship between Veterans' use of coping strategies and treatment engagement for depression may not be readily apparent without in-depth exploration. In VA primary care clinics, nurse care managers and behavioral health providers should explore how Veterans' methods of coping may impact treatment engagement.
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