2005 HSR&D National Meeting Abstract
1080 — Screening, Assessment, and Management of Depression and Alcohol Misuse in Primary Care: Effects of the Behavioral Health Laboratory
The purpose of this project was to assess the utility and feasibility of a telephone based systematic clinical assessment service, the Behavioral Health Laboratory (BHL), in the context of primary care. The BHL is a service that provides Primary Care Providers (PCPs) with a summary of mental health and substance abuse (MH/SA) symptoms and provides treatment recommendations, including triage to specialty MH/SA services. The BHL was implemented to assist in the evaluation of patients who screened positively for depression and/or at-risk alcohol use at an annual clinical appointment or who were identified through routine care.
Results from systematic screening of primary care patients were extracted during a period of 6 months prior to implementation of the BHL and several months after implementation of the BHL. Descriptive results of the 415 evaluations conducted during this time were available as well as chart reviews of 120 subjects evaluated by the BHL. In total, over 1400 evaluations have been completed in 18 months.
Results suggest an association between the implementation of the BHL and an increase in the proportion of patients screened for depression in primary care, resulting in a 24.4% reduction in those not screened. In addition, there was a decrease in the proportion of patients who screened negatively (89.7% versus 80.1%). Fewer patients were identified via alcohol screening, though assessment and referral were conducted in a similar process.
Introducing the BHL into primary care was associated with an apparent change in clinical practice in primary care at the Philadelphia VA Medical Center. The improvements in screening rates suggest that primary care clinicians were able to complete screening in a group that was previously difficult to assess. This group of patients may have greater vulnerability to MH/SA problems given the change in screening outcomes. The BHL offers a practical, low cost method of assessment, monitoring and treatment planning for patients, identified in primary care, with MH/SA needs. Thus the BHL provides several of the key elements to quality care including follow-up assessment of screening, the capacity for treatment planning, and ongoing monitoring.