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Improving Depression Care Through Primary Care-Mental Health Collaboration

Fickel JJ, Parker LE, Yano EM, Kirchner J, Ritchie MJ. Improving Depression Care Through Primary Care-Mental Health Collaboration. Paper presented at: VA QUERI National Meeting; 2003 Dec 10; Washington, DC.

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Objectives: Primary care-mental health collaboration aims to improve detection and treatment of depression through formalization and coordination of professional roles. We evaluated baseline variations in provider collaboration in preparation for an evidenced based quality improvement (EBQI) initiative, Translating Interventions for Depression on Effective Care Solutions (TIDES). TIDES is a QUERI-supported program designed to use an EBQI process to implement a collaborative-care model for depression in VA primary care clinics.Methods/Approach: We conducted semi-structured telephone interviews with 30 primary care (PC) and mental health care (MH) leaders from 10 participating VA clinics regarding depression detection and management, and analyzed transcripts for relevant themes.Results/Findings: There was a wide range in extent and quality of PC-MH collaboration at the sites. Perceptions about barriers to appropriate management of depression and collaboration differed between MH and PC providers in several ways. PC doctors reported moderately-high comfort levels with depression care, but noted inadequate time and too few PC providers for managing depression. MH identified more barriers, including inadequate PC training and experience with depression. Although there was consensus that MH providers are very available for informal consultation with PC providers, there were few formal joint case conference activities.Implications: Many barriers exist to collaboration between PC and MH providers, with fair-to-poor levels of collaboration in half the sites. PC and MH providers view collaboration differently. Better understanding of these barriers and differences in perceptions is needed to improve collaboration and the quality of depression care. Provider collaboration affects clinics' abilities to implement evidence-based quality improvement for depression care. Greater emphasis on improving generalist-specialist collaboration is central to improving outcomes for veterans with depression.

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