Wednesday, February 16, 2022

Collaborative Care Successful in Urban Setting but Many Patients Choose Not to Participate

Despite a high rate of screening minority patients for anxiety and depression in seven primary care centers that used the Collaborative Care Model (CoCM), only 56% of eligible patients engaged in care, and 25% did not return for at least one follow-up appointment, a report in Psychiatric Services has found. Nevertheless, 58% who received care under the model had significant clinical improvement.

“These findings are sobering and indicate that even with the CoCM, considered a gold-standard behavioral health integration model in primary care, more work is needed to identify and overcome barriers to engaging vulnerable patients and advance the model’s impact,” wrote Michelle Blackmore, Ph.D., of the Montefiore Medical Center in New York and colleagues.

CoCM has an extensive evidence base, and care provided under the model is reimbursed by the Centers for Medicare and Medicaid Services. Beginning in 2015, CoCM was implemented in seven primary care practices serving patients from racial-ethnic minority groups in the Bronx and lower Westchester counties of New York state. Many of the patients were predominantly Medicaid beneficiaries.

In total, 88,236 of patients (87%) were administered the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7) in a primary care visit. Of these, 11,886 (13%) screened positive for clinically significant depressive or anxiety symptoms, and 6,849 (8%) had clinically significant comorbid anxiety and depression.

In total, 5,247 patients (56%) engaged in CoCM—defined as completing an initial assessment with a preliminary diagnosis and agreeing to start treatment—during the three-year study; 3,957 had one or more follow-ups after 10 to 14 weeks, during which the PHQ-9 or GAD-7 was again administered. For patients with at least one follow-up by 10 to 14 weeks, 58% had improved scores on the PHQ-9, GAD-7, or both; 19% of patients with depression and 20% of patients with anxiety were in remission (defined as scores of less than 5 on the PHQ-9 and GAD-7).

Twenty-five percent of patients who were eligible for collaborative care did not return for at least one follow-up appointment after agreeing to start treatment. Perceived stigma about mental illness, transportation problems, and family and work responsibilities may have impeded engagement, the researchers wrote.

“Improving the engagement of vulnerable patients in integrated models such as the CoCM can enhance receptivity and access to behavioral health treatment, representing key steps toward addressing health care inequity and increasing population impact,” the researchers wrote. “However, our findings also highlighted a significant need for targeted CoCM modifications to improve initial and ongoing patient engagement for this patient population.”

For more information, see the Psychiatric News article “Three Health Systems Find Success With Collaborative Care.”

(Image: iStock/Pornpak Khunatorn)

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