Collaborative depression care: history, evolution and ways to enhance dissemination and sustainability
Section snippets
New collaborative care research initiatives
Fig. 2 describes four initiatives that are extending primary care research on collaborative care, including organized dissemination efforts to integrate collaborative care into large systems of care such as the Veterans Affairs (VA) system as well as primary care clinics throughout the state of Minnesota [the DIAMOND (Depression Improvement Across Minnesota: Offering a New Direction) project]; care management approaches for patients with depression and other medical illnesses that attempt to
Combined case management approaches for depression and comorbid medical illnesses
Despite evidence that collaborative care teams that are integrated into primary care improve the quality of care and outcomes of chronic illnesses like depression, diabetes and cardiovascular disease, most systems of care have struggled with how to pay for these quality-of-care improvements. Since it will be difficult to develop team approaches for each chronic illness and the most costly and time-consuming patients often have depression and other medical comorbidities [63], trials of
New populations and settings
In contrast to the 37 trials of collaborative care tested in adult populations with depression, there is only one trial testing collaborative care in child/adolescent settings [72]. NIMH has recently funded the second trial of collaborative care vs. usual primary care for adolescents with major depression and also funded the first trial of a telemedicine adaptation of collaborative care for rural children with ADHD. These are important trials given the high prevalence of depression [73] and
Conclusion
Over 20 years of federal and foundation funding has created an extensive evidence base for collaborative care for depression and increasingly also other common mental disorders in primary care settings. Challenges now include local and federal collaboration on financing mechanisms to facilitate the implementation of such evidence-based approaches in diverse payment environments, and development of research to determine optimum ways to support and speed-up dissemination.
NIMH has recently funded
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Clinical Update: Collaborative Mental Health Care for Children and Adolescents in Pediatric Primary Care
2023, Journal of the American Academy of Child and Adolescent PsychiatryCitation Excerpt :The PCMH model has been shown to improve patient-centered access, reduce care fragmentation, better manage chronic conditions, improve patient experience and staff satisfaction, and lower health care costs.26 As the substantial contribution of MH problems to the perpetuation of medical illness and the concomitant increase in overall treatment costs became widely recognized, the chronic care and PCMH models were adapted to include the identification and management of MH problems, with an initial focus on depression and anxiety in adult patients.28 Collaborative MH care in adult primary care is based upon 5 principles similar to those of the chronic care and PCMH models (Table 1).29
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