Developing effective collaboration between primary care and mental health providers.

Area of Science:

• Healthcare systems research
• Mental health services research
• Primary care research

Background:

• Effective management of depression in primary care (PC) necessitates system-level interventions and collaboration between primary care providers (PCPs) and mental health providers (MHPs).
• The Department of Veterans Affairs (VA) initiated a multisite study to evaluate a multifaceted program for improving major depression management in PC practices.

Purpose of the Study:

• To describe the development of an effective collaboration system for managing depression in PC patients within the VA system.
• To facilitate adoption of depression care improvements through the Translating Initiatives for Depression into Effective Solutions (TIDES) project.

Main Methods:

• A telephone-based depression care management program utilized Depression Case Managers (DCMs) supervised by MHPs to support PCPs.
• A Collaborative Care Workgroup (CWG) was established to foster collaboration among PCPs, MHPs, and DCMs.
• The CWG employed a 3-phase process: identifying barriers, targeting problems and solutions, and institutionalizing ongoing improvements.

Main Results:

• The CWG successfully addressed barriers between PCPs and MHPs, achieving high rates of PC patients with depression being followed by PCPs (82%) and referred patients attending MHP appointments (88%).
• Significant improvements were observed in PC patients with depression receiving antidepressants (76%).
• Site-specific protocols for managing suicidal ideation in PC patients were implemented.

Conclusions:

• The developed steps effectively improved and sustained collaboration between PCPs and MHPs in PC practices.
• This model provides a valuable guide for enhancing collaborative care for depression and other chronic disorders within PC clinics.