Article

Screening, assessment, and management of depression in VA primary care clinics - The Behavioral Health Laboratory

William Penn University, Filadelfia, Pennsylvania, United States
Journal of General Internal Medicine (Impact Factor: 3.42). 02/2006; 21(1):46-50. DOI: 10.1111/j.1525-1497.2005.0267.x
Source: PubMed

ABSTRACT

The purpose of this project was to assess the utility and feasibility of a telephone-based systematic clinical assessment service, the Behavioral Health Laboratory (BHL), in the context of primary care. The BHL is a clinical service that provides primary care providers with an assessment and a summary of mental health and substance abuse (MH/SA) symptoms and provides treatment decision support, including triage to specialty MH/SA services. The BHL was implemented to assist in the evaluation of patients who screened positively for depression at an annual clinical appointment or who were identified through routine care.
Results from systematic screening of primary care patients were extracted during a period of 6 months prior to implementation of the BHL and after implementation of the BHL. Descriptive results of the 580 evaluations conducted during this time were available.
Results suggest an association between the implementation of the BHL and an increase in the proportion of patients screened for depression in primary care. In addition, there was an increase in the proportion of patients who screened positively (2.8% vs 7.0%). The BHL was successful in providing a comprehensive assessment for 78% of those referred. Significant co-occurring mental illness and substance misuse were found among those assessed.
Introducing the BHL into primary care was associated with an apparent change in clinical practice in primary care at the Philadelphia VA Medical Center. Not only were more patients identified, the broad-based approach of the BHL identified significant comorbidity with alcohol misuse, illicit drugs, and suicidal ideation, symptoms likely to have been missed in routine clinical practice. The BHL offers a practical, low-cost method of assessment, monitoring, and treatment planning for patients identified in primary care with MH/SA needs.

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    • "monitoring of medication adherence, and structured, measurement-based assessment of progress over time, with facilitation of changes in treatment when necessary . A care manager completes a baseline measure of the veteran's symptoms (see Appendix 4.1 for a sample care management baseline report) and calls the patient on a predetermined, evidence-informed schedule (Oslin et al, 2006; Tew et al, 2010). "

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    • "The BHL is an integrated primary care/mental health care service at the PVAMC that provides comprehensive substance use and psychiatric assessments by technicians under the supervision of psychologists, nurses and a psychiatrist. The laboratory assessments included a telephonic interview consisting of socio-demographic and psychiatric measures (Oslin et al., 2006). The interview assesses information in the following domains: baseline demographic data, Mini International Neuropsychiatric Interview (MINI) modules for mood disorders, anxiety disorders, and alcohol abuse/dependence (Sheehan et al., 1998); Patient Health Questionnaire-9 item scale (PHQ-9) (Kroenke, Spitzer, & Williams, 2001), PTSD Check List (PCL) (Blanchard, Jones- Alexander, Buckley, & Forneris, 1996), history of past episodes of depression, current antidepressant medications, alcohol consumption, smoking, use of illicit substances, 5-item Paykel Scale for suicidal ideation (Paykel, Myers, Lindenthal, & Tanner, 1974), Blessed, Tominson, & Roth, (1968) (Katzman et al., 1983), Short Form-12 item scale (SF-12) (Ware, Kossinski, & Keller, 1998), Work Limitation Questionnaire (Lerner et al., 2001), treatment satisfaction, insomnia, social support, bodily pain and diet. "
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    • "The mission of the BHLs is to provide comprehensive psychosocial assessments (with efficient, same-day feedback summaries provided to each patient's clinician) for VHA patients in need of mental health care during primary care visits (Oslin et al., 2006). The BHLs have increased the detection of problematic substance use and suicidal ideation, symptoms which may have been missed in routine clinical practice, among veterans using VHA primary care services (Oslin et al., 2006, 2004) advocate for universal IPV screening for women. In addition, the feasibility of implementing universal IPV screening programs within large, managed health care systems has been demonstrated through Kaiser Permanente's successful screening program (McCaw, 2011;McCaw & Kotz, 2009;McCaw, Berman, Syme & Hunkeler, 2001). "

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