A Depression Care Management Project to Improve Treatment Coordination and Outcomes in Patients With Comorbid Conditions
depression, care management
Background/Aims: Appropriate clinical management of major depression and comorbid medical conditions represents a significant challenge for providers. Adopting a patent-centered treatment perspective, qualified nonphysician behavioral health specialists can support monitoring complex needs, enhance care provision and satisfaction with medical encounters, and improve cost-effective outcomes. This demonstration project evaluated a depression management program, examining effects on depressive symptoms, chronic disease and medication management, utilization and treatment costs.
Methods: Beginning January 2015, the program offers enrollment to primary care patients scoring above 15 on the Patient Health Questionnaire-9 (PHQ-9). Individuals receive an integrated, holistic health care plan, psychiatric consultations as needed, education concerning medications and side effects, and proactive follow-up. Besides facilitating team communication, the care manager provides evidence-based brief counseling (e.g. motivational interviewing, behavioral activation) and initiates treatment modifications to optimize clinical gains. As participants complete 6 months or achieve remission of depression, we evaluate changes in PHQ-9 and satisfaction ratings while linking to administrative data on utilization, prescriptions and costs.
Results: To date, 58 patients are enrolled, with mean age of 51.5 (range: 12–88) and 72% women. Among early notable findings, substantial improvements were observed in abatement of clinical depression. Of 48 individuals with subsequent PHQ-9s, their mean decline was 7.7 points; 50% exhibited remittance and 86% showed clinical improvement. Other analysis suggests a slight drop in emergency visits and fewer prescriptions across most psychotropic and medical drug classes, controlling for program duration. Patient satisfaction with the program is quite positive, especially perceived inclusion when discussing treatment strategies and provider attention to patient mood. Ongoing work will examine changes in specialty mental health care, admissions and costs in comparison to a similar clinic cohort, matching for demographics and clinical characteristics.
Conclusion: Consistent with national efforts to better engage patients in their health care decisions, this care management program employs highly qualified, lower-cost providers for most encounters. Such personalized, coordinated treatment of comorbid conditions within a primary care environment offers tremendous promise for improving depression and quality of life while proactively reducing unnecessary treatment and system costs. Further longitudinal analyses will monitor these impressive short-term benefits as we fully examine implementation of a truly patient-centered, feasible care approach.
Zeber JE, Copeland LA, Ruktanonchai D, Liao IC, Embry J. A depression care management project to improve treatment coordination and outcomes in patients with comorbid conditions. J Patient Cent Res Rev. 2016;3:178-9.