Collaborative care models for the treatment of depression. Based on a presentation by Wayne Katon, MD.
The quality of treatment of depression in the primary care setting is limited by inadequate patient education, lack of adherence to treatment regimens, poor patient follow-up, and the absence of close collaboration between medical and mental health systems. Integrated models of care may help overcome some of these barriers and improve adherence, satisfaction with care, and outcomes. The health and economic outcomes of randomized controlled trials in which 2 models of collaborative care--psychiatrist and psychiatrist/psychologist plus primary care--were compared with usual primary care. Interventions were delivered at multiple levels and included enhanced patient education and monitoring, physician training, patient-physician interaction, and integration of a psychiatrist or psychologist into the primary care setting. After the interventions, patients with major depression showed significant improvements in adherence, satisfaction with care, and depressive outcomes, whereas, in patients with minor depression, outcomes were not significantly affected by the intervention. An analysis revealed that the cost of the interventions was higher than usual care, and that there was little evidence of any cost offset. However, in terms of cost effectiveness, the cost of successfully treating one patient with major depression was lower with the interventions, and the incremental costs of collaborative intervention were substantially lower than the usual primary care costs.
D003266:Continuity of Patient Care / Q000458:organization & administration*; D003863:Depression / Q000628:therapy*; D017048:Health Care Costs; D006801:Humans; D017146:Models, Organizational; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D011570:Psychiatry / Q000191:economics / Q000458:organization & administration*; D014481:United States