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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3098 — National Implementation of VA’s Primary Care-Mental Health Integration: Expanding Beyond Depression Care Management?

Oishi SM, and Rose DE, VA Greater Los Angeles Healthcare System; Post EP, VA Ann Arbor Healthcare System; Schectman G, VA Office of Patient Care Services; Stark R, VA Primary Care Operations; Rubenstein L, VA Greater Los Angeles Healthcare System; Chaney E, VA Puget Sound Healthcare System; Canelo I, and Yano EM, VA Greater Los Angeles Healthcare System;

The Translating Initiatives for Depression into Practice (TIDES) care management model was developed to facilitate management of uncomplicated depression in primary care (PC) with care manager-facilitated referral to specialty mental health (MH) for complex cases. In practice, patients refusing specialty MH care are sometimes cared for by depression care managers for additional conditions (anxiety, alcohol misuse/abuse, PTSD). We assessed the spread of TIDES care management across additional MH conditions, and organizational predictors of such model adaptation.

We surveyed PC directors at 248 geographically-distinct VA sites of care (2008-09). Items assessed the number of sites employing the TIDES depression care model, MH conditions cared for by TIDES care managers, and PC organizational factors. We conducted bivariate analyses to assess organizational predictors of conditions cared for by TIDES care managers.

Response rate was 92% (n = 229). 113 sites (49%) said the TIDES model was in place, planned, or in process. Of these, 54 (48%) said care managers provided care for all four conditions (depression, alcohol problems, PTSD, anxiety disorders). Thirty-two (28%) reported caring for depression only. In bivariate analyses, organizational factors associated with TIDES care for 2-4 conditions included CPRS (Computerized Patient Record System)challenges such as volume of CPRS alerts. Additional factors associated with caring for individual conditions included: Volume of CPRS alerts, coordination problems with MH, and sufficiency of data analysts and quality improvement personnel, for alcohol; sufficiency of data analysts, patient education space, and space for patient groups, for PTSD; and volume of CPRS alerts for anxiety.

Organizational challenges in informatics, communication, and resource availability may impact the feasibility of modifying the care manager role to support multiple MH conditions in PC; however, the impact of modification on effectiveness is unclear.

Standard minimum requirements for the scope and process of services provided under the VA Primary Care-Mental Health Integration Initiative include a focus on prevalent conditions in primary care. The degree to which the evidence-based TIDES model can be modified to care for patients with multiple mental health conditions without diluting effectiveness must be assessed.

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