Early Follow Up Found to Be Key to Patient Success in Collaborative Care of Depression

Patients with depression who were contacted by a care manager at least once within four weeks of their initial visit were more likely to achieve improvements in symptoms and had a shorter time to improvement than those who were not contacted early on, according to a study of a collaborative care model (CCM) published today in Psychiatric Services in Advance. For patients who did not achieve improvements by week 8, consultation about the case between the primary care provider and the team psychiatrist by week 12 predicted improvement within six months.

According to the study authors, who were led by Jürgen Unützer, M.D., M.P.H. (pictured left), of the University of Washington, the findings of the study highlight the importance of patient engagement in the early phase of treatment and timely psychiatric consultation when patients do not experience improvement in the early phases of the collaborative care model.

The researchers analyzed outcomes for over 5,400 adult psychiatric patients who had initiated care in clinics that were part of the Mental Health Integration Program (MHIP), a publicly funded implementation of the CCM in a network of more than 100 community health centers in the state of Washington. The group examined whether care manager follow-up and psychiatric consultation were associated with clinically significant improvements in depression (defined as having at least one follow-up PHQ-9 score of less than 10 or achieving a 50% or more reduction in the PHQ-9 score within 24 weeks of initial contact).

Four-week follow-up was associated with a greater likelihood of achieving improvement in depression and a shorter time to improvement. Psychiatric consultation was also associated with a greater likelihood of improvement but not with a shorter time to improvement.

“Our findings support efforts to improve fidelity to these two process-of-care tasks and to include these two tasks among quality measures for CCM implementation,” the study authors wrote. “Future studies should seek to assess the relative importance of other key tasks of CCM and test implementation strategies (for example, pay for performance) to encourage and enable high fidelity to tasks found to contribute to good patient outcomes,” the study authors commented.

To read about some of APA’s efforts to facilitate broader use of collaborative care models, see the Psychiatric News article “APA Urges Creation of Payment Codes Specific to Collaborative Care Model.”