Elsevier

General Hospital Psychiatry

Volume 32, Issue 5, September–October 2010, Pages 456-464
General Hospital Psychiatry

Collaborative depression care: history, evolution and ways to enhance dissemination and sustainability

https://doi.org/10.1016/j.genhosppsych.2010.04.001Get rights and content

Abstract

Objective

To describe the history and evolution of the collaborative depression care model and new research aimed at enhancing dissemination.

Method

Four keynote speakers from the 2009 NIMH Annual Mental Health Services Meeting collaborated in this article in order to describe the history and evolution of collaborative depression care, adaptation of collaborative care to new populations and medical settings, and optimal ways to enhance dissemination of this model.

Results

Extensive evidence across 37 randomized trials has shown the effectiveness of collaborative care vs. usual primary care in enhancing quality of depression care and in improving depressive outcomes for up to 2 to 5 years. Collaborative care is currently being disseminated in large health care organizations such as the Veterans Administration and Kaiser Permanente, as well as in fee-for-services systems and federally funded clinic systems of care in multiple states. New adaptations of collaborative care are being tested in pediatric and ob-gyn populations as well as in populations of patients with multiple comorbid medical illnesses. New NIMH-funded research is also testing community-based participatory research approaches to collaborative care to attempt to decrease disparities of care in underserved minority populations.

Conclusion

Collaborative depression care has extensive research supporting the effectiveness of this model. New research and demonstration projects have focused on adapting this model to new populations and medical settings and on studying ways to optimally disseminate this approach to care, including developing financial models to incentivize dissemination and partnerships with community populations to enhance sustainability and to decrease disparities in quality of mental health care.

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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