Collaborative Care model for depression and anxiety problems

Quick fact – Only 50% of patients who receive a referral for specialty mental health care ever follow through with the referral. Among those who do, many do not have more than one visit.

Issue – Because of stigma, shortage of mental health specialists, and lack of follow through, many people with behavioral health problems (depression, anxiety, alcohol or substance abuse) are robbed of their chance to lead healthy and productive lives.

Integrated care – where a medical office also has a behavioral health component/staff.  This is convenient for patients, a one-stop shop, and happens in one visit.

Collaborative care – specific type of integrated care, developed at University of Washington, that treats depression and anxiety that require systematic follow-up due to persistent nature.  Focused on a defined patient population tracked in a registry, measurement-based practice and treatment to target.  Support team made up of: primary care providers, embedded behavioral health professionals who provide evidence-based medication and/or psychosocial treatments, with regular psychiatric case consultation and treatment adjustments for patients who are not improving as expected.

Principles that created collaborative care

Principles of effective chronic care include: Patient-centered team care; Population-based Care; Measurement-based Treatment to Target; Evidence-Based Care; Accountable Care

-Research culture originated collaborative care and has now been tested in more than 80 randomized controlled trials in the US and abroad.  There are several recent meta-analyses that make it clear that collaborative care consistently improves on care as usual.  It leads to better patient outcomes, better patient and provider satisfaction, improved functioning, and reductions in health care costs, achieving the Triple Aim of health care reform. Collaborative care necessitates a practice change on multiple levels and is nothing short of a new way to practice medicine, but it works. The bottom line is that patients get better.

Additional Reference

I managed to find the entire research document entitled “Collaborative care for depression and anxiety problems” by Archer, et al, 2012.  232 pages.

Cochrane site on Collaborative care for people with depression and anxiety

Cochrane systematic review

Resource Library to find materials about collaborative care.

Implementation Guide to walk through the process of implementation.

XREF to two downloaded articles —

The role of relapse prevention for depression in collaborative care: A systematic review and

Does collaborative care improve social functioning in adults with depression? The application of the WHO ICF framework and meta-analysis of outcomes


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