Collaborative care models for depression - Time to move from evidence to practice

Department of Psychiatry and Behavioral Sciences, University of Washington Seattle, Seattle, Washington, United States
Archives of Internal Medicine (Impact Factor: 13.25). 12/2006; 166(21):2304-6. DOI: 10.1001/archinte.166.21.2304
Source: PubMed

ABSTRACT In this issue of the ARCHIVES

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    • ". Yet, SCC implementation in daily practice is difficult and produces variable results [4] [16] [18] [24] [33]. "
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    ABSTRACT: The mental health burden on primary care is substantial and increasing. Anxiety is a major contributor. Stepped collaborative care (SCC) is implemented worldwide to improve patient outcomes, but long term real-world evaluations of SCC do not exist. Using routinely used electronic medical records from more than a decade, we investigated changes in anxiety prevalences, whether physicians made distinction between non-severe and severe anxiety, and whether these groups were referred and treated differently, both non-pharmacologically and pharmacologically. Retrospective assessment of anxiety care parameters recorded by 54 general practitioners between 2003 and 2014, in the electronic medical records of a dynamic population of 49,841-69,413 primary care patients. Substantial shifts in anxiety care parameters have occurred. The prevalence of anxiety symptoms doubled to 0.9% and of anxiety disorders almost tripled to 1.1%. Use of ICPC codes seemed comprehensive and use of instruments to support in anxiety level differentiation increased to 13% of anxiety symptom and 7% of anxiety disorder patients in 2014. Minimal interventions were used more frequently, especially for anxiety symptoms (OR 21 [95% CI 5.1-85]). The antidepressant prescription rates decreased significantly for anxiety symptoms (OR 0.5 [95% CI 0.4-0.8]) and anxiety disorders (OR 0.6 [95% CI 0.4-0.8]). More patients were referred to psychologists and psychiatrists. We found shifts in anxiety care parameters that follow the principles of SCC. Future primary care research should comprehensively assess the use of the SCC range of therapeutic options, tailored to patients with all different anxiety severity levels. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    European Psychiatry 07/2015; DOI:10.1016/j.eurpsy.2015.06.002 · 3.21 Impact Factor
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    • "The majority of the research on collaborative care has been carried out with insured patient populations who have more resources and greater access to mental and physical health services than is typical of uninsured patient populations. Efforts to disseminate collaborative care have been undertaken by several large, resourced systems of care, including the Veterans Administration , Kaiser Permanente, and the Bureau of Primary Care's clinic system (Katon & Unu¨tzer, 2006). There have been a limited number of reports of collaborative care models that have been implemented in settings that serve low-income, uninsured populations (Little, 2009; Mauksch et al., 2007). "
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    ABSTRACT: Low-income, uninsured immigrants are burdened by poverty and a high prevalence of trauma exposure and thus are vulnerable to mental health problems. Disparities in access to mental health services highlight the importance of adapting evidence-based interventions in primary care settings that serve this population. In 2005, the Montgomery Cares Behavioral Health Program began adapting and implementing a collaborative care model for the treatment of depression and anxiety disorders in a network of primary care clinics that serve low-income, uninsured residents of Montgomery County, Maryland, the majority of whom are immigrants. In its 6th year now, the program has generated much needed knowledge about the adaptation of this evidence-based model. The current article describes the adaptations to the traditional collaborative care model that were necessitated by patient characteristics and the clinic environment.
    American Journal of Orthopsychiatry 10/2011; 81(4):543-51. DOI:10.1111/j.1939-0025.2011.01125.x · 1.50 Impact Factor
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    • "Hopefully the papers in this issue will advance both the conceptual and evidentiary clarity to inform what such a presence should look like and what it should do. However, we need to heed Katon and Unutzer's observation after reviewing the research evidence demonstrating the effectiveness of treating depression in primary care, that the findings are sufficiently compelling to suggest we should stop doing further research in the area and move to implementing the findings in general practice (Katon & Unutzer, 2006). So to start following their advice, here are the actions for the field that will allow that to happen. "
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    ABSTRACT: Psychology and other behavioral health professions have amassed a broad empirical and clinical literature suggesting many medical presentations are best responded to with the addition of evidence based behavioral interventions. Despite this, psychology has not achieved a regular presence as part of medical practice. We suggest specific reasons for the current state of affairs including clinical, operational, societal labels, financial and training dimensions. Medical, psychological, administrative, and financial perspectives are reviewed. If the goals of health care system reform are to be reached then we must identify and challenge the current limitations of health care. This paper will identify the elements that need to be changed in order for psychology to be integrated into medicine rather than excluded from its policy, planning and operations.
    Journal of Clinical Psychology in Medical Settings 03/2009; 16(1):4-12. DOI:10.1007/s10880-009-9146-y · 1.49 Impact Factor
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