| Principal Investigator: | Robert J. Machado, MSN, PMHCNS-BC |
| Co-Principal Investigator/Collaborator: | Suzanne Foster |
| Organization: | Bay Pines VA Healthcare System |
Abstract
Problem
Depression is a leading cause of disability in the United States and is the second most prevalent, chronic, disabling and costly illness in VA healthcare. Depression is prevalent among primary care patients but is underdected and under treated leading to an increase risk for suicide. Patients often prefer treatment for depression in a primary care setting rather than mental health to reduce costs and avoid stigmatization.
Evidence
Translating Initiatives for Depression into Effective Solutions (TIDES) is an evidence based collaborative approach to depression management that utilizes the expertise of mental health specialists to support primary care providers (PCP) in treating their patients with uncomplicated depression within the primary care setting. TIDES data reflects that 90% of patients involved in their program achieved resolution of their depression.
Strategy
Depression Care Management (DCM) is based on the TIDES model. DCM mental health nurses conduct systematic telephone assessments of primary care patients evaluating their depressive symptoms, providing educational information, monitoring medication compliance, communicating findings to the primary care clinicians, and recommending treatment changes.
Practice Change
PCP’s are confident in prescribing antidepressants in the primary care setting but frustrated with their inability to provide adequate follow-up care and so refer patients to mental health. Intense marketing and education was required to change PCP’s practice of mental health referrals to a telephone based mental health program within the primary care setting.
Evaluation/Results
In the 7 months of implementation the program has received over 100 referrals from PCP’s and continues to grow as they buy-into the program. Graduates from the program show a marked reduction in depression and patient satisfaction is high.
Recommendations
Extensive and continuous marketing of the program prompts the PCP’s in continuing to refer patients to the DCM program rather than to mental health services.
Bibliography
- Chaney E, Vollen K, Revay B, Berry K, Vivell S, Rubenstein L. Treating Depression in Primary Care (TIDES): Mental Health QUERI Telephone-Based Collaborative Care Spread Project. December 2003.
- Felker BL, Chaney E, Rubenstein LV, et al. Developing Effective Collaboration between Primary Care and Mental Health Providers. Prim Care Companion J Clin Psychiatry. 2006; 8(1): 12–16.
- Fortney J, Davis A, Pyne J, Raney W, Ackerman S. Depression Care Manager Training Manual. Version 1.0. March 20, 2007.
- Gilbody S, Bower P, Fletcher J, Richards D, Sutton AJ. Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Arch Intern Med. Nov 27, 2006; 166 (21): 2314–2321.
- Williams JW, Jr.,Gerrity M, Holsinger T, Dobscha S, Gaynes B, Dietrich A. Systematic review of multifaceted interventions to improve depression care. Gen Hosp Psychiatry. Mar-Apr 2007; 29(2): 91–116.