Effectiveness of collaborative care depression treatment in Veterans' Affairs primary care.
OBJECTIVE
To compare collaborative care for treatment of depression in primary care with consult-liaison (CL) care. In collaborative care, a mental health team provided a treatment plan to the primary care provider, telephoned patients to support adherence to the plan, reviewed treatment results, and suggested modifications to the provider. In CL care, study clinicians informed the primary care provider of the diagnosis and facilitated referrals to psychiatry residents practicing in the primary care clinic.


METHODS
Patients were randomly assigned to treatment model by clinic firm.


METHODS
VA primary care clinic.


METHODS
One hundred sixty-eight collaborative care and 186 CL patients who met criteria for major depression and/or dysthymia.


METHODS
Hopkins Symptom Checklist (SCL-20), Short Form (SF)-36, Sheehan Disability Scale.


RESULTS
Collaborative care produced greater improvement than CL in depressive symptomatology from baseline to 3 months (SCL-20 change scores), but at 9 months there was no significant difference. The intervention increased the proportion of patients receiving prescriptions and cognitive behavioral therapy. Collaborative care produced significantly greater improvement on the Sheehan at 3 months. A greater proportion of collaborative care patients exhibited an improvement in SF-36 Mental Component Score of 5 points or more from baseline to 9 months.


CONCLUSIONS
Collaborative care resulted in more rapid improvement in depression symptomatology, and a more rapid and sustained improvement in mental health status compared to the more standard model. Mounting evidence indicates that collaboration between primary care providers and mental health specialists can improve depression treatment and supports the necessary changes in clinic structure and incentives.
Hedrick
Susan C
SC
Health Services Research and Development Center of Excellence, the VA Puget Sound Health Care System, Seattle, Wash 98108, USA. susan.hedrick@med.va.gov
Chaney
Edmund F
EF
Felker
Bradford
B
Liu
Chuan-Fen
CF
Hasenberg
Nicole
N
Heagerty
Patrick
P
Buchanan
Jan
J
Bagala
Rocco
R
Greenberg
Diane
D
Paden
Grady
G
Fihn
Stephan D
SD
Katon
Wayne
W
D000328:Adult; D000368:Aged; D003863:Depression / Q000628:therapy*; D005260:Female; D006304:Health Status; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D008875:Middle Aged; D017146:Models, Organizational; D010348:Patient Care Team / Q000458:organization & administration* / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration*; D011570:Psychiatry / Q000193:education / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration; D014728:Veterans