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.”

Collaborative Care: An Integral Part of Psychiatry's Future

APA President Jeffrey Lieberman, M.D., is using the Psychiatric News Alert as a forum to reach APA members and other readers. This column was written by Dr. Lieberman and Jurgen Unutzer, M.D. Please send your comments to pnupdate@psych.org.

In 1974, music critic Jonathan Landau penned a classic article in which he stated, “I have seen the future of rock and roll and its name is Bruce Springsteen.” Landau was commenting on his impression of the debut album of the then-fledgling rock star. If you will permit my imaginative analogy, I believe that the same can be said about the collaborative care model with respect to the future of psychiatry. For this reason I invited Jürgen Unützer to co-author this column for Psychiatric News. 

With the enactment of the Affordable Care Act, the rise of accountable care organizations and patient-centered medical homes, and the increased national attention on mental health, psychiatrists and primary care providers have an unprecedented opportunity to join together and work collaboratively on increasing the overall health of millions of Americans. APA recognizes this opportunity and has been actively involved in efforts to improve integration and collaboration with our primary care colleagues.

As one of the largest medical specialties, psychiatry is an important component of the physician workforce in the United States, but psychiatrists are distributed unequally around the country. More than half of the counties in the United States don’t have a single practicing psychiatrist. Only about 1 in 10 adults with a diagnosable mental disorder receives care from a psychiatrist in any given year and patients are much more likely to receive mental health treatment from their primary care provider than from a psychiatrist. It is well known and often said that 40 percent of primary care (adult and pediatric) involves dealing with psychiatric problems. Our colleagues in primary care are well aware of the substantial challenges related to treating the millions of patients who present with mental health problems in their offices every year and report serious limitations in the support they receive from psychiatrists and other mental health specialists.

To read more, click here.

You can follow Dr. Lieberman on Twitter at @DrJlieberman. To do so, go to https://twitter.com/DrJlieberman, log in or register, and click on “Follow.”