title: Outcomes of a quality improvement project integrating mental health into primary care.
abstract: OBJECTIVE
  Depression is commonly seen, but infrequently adequately treated, in primary care clinics. Improving access to depression care in primary care clinics has improved outcomes in clinical trials; however, these interventions are largely unstudied in clinical settings. This study examined the effectiveness of a quality improvement project improving access to mental healthcare in a large primary care clinic.
  
  
  METHODS
  A before-after study evaluating the efficacy of the integration of a primary mental healthcare (PMHC) clinic into a large primary care clinic at the White River Junction, Vermont Veterans Affairs Medical Center (VAMC). In the before period (2003), a traditional referral and schedule model was used to access mental healthcare services. Patients who had screened positive for depression using a depression screen for 6 months after entry into either model were retrospectively followed. VA clinics without a PMHC were used as a control. The proportion of patients who received any depression treatment and guideline-adhering depression treatment in each model was compared, as well as the volume of patients seen in mental health clinics and the wait time to be seen by mental health personnel.
  
  
  RESULTS
  383 and 287 patients screened positive for depression at VAMC and the community-based outreach clinic, respectively. Demographics of the before and after cohorts did not differ. The PMHC model was associated with a greater proportion of patients who had screened positive for depression obtaining some depression treatment (52.3% vs 37.8%; p<0.001), an increase in guideline-adherent depression treatment for depression (11% vs 1%; p<0.001).
  
  
  CONCLUSIONS
  Implementation of the PMHC model was associated with more rapid and improved treatment for depression in the population of patients who screened positive for depression. More widespread implementation of this model should be investigated.
authors.affiliation: Outcomes REAP, White River Junction VAMC, White River Junction, Vermont 05009, USA. bradley.v.watts@dartmouth.edu
authors.forename: Bradley V
authors.initials: BV
authors.lastname: Watts
authors.forename: Brian
authors.initials: B
authors.lastname: Shiner
authors.forename: Andrew
authors.initials: A
authors.lastname: Pomerantz
authors.forename: Patricia
authors.initials: P
authors.lastname: Stender
authors.forename: William B
authors.initials: WB
authors.lastname: Weeks
mesh_terms: D000368:Aged; D001071:Appointments and Schedules; D019033:Delivery of Health Care, Integrated; D003866:Depressive Disorder / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence; D006787:Hospitals, Veterans / Q000592:standards; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration* / Q000592:standards; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000379:methods*; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D013997:Time Factors; D014707:Vermont