Cognitive behavioral therapy for depressive disorders: Outcomes from a multi-state, multi-site primary care practice.

Background: Individuals with depressive disorders often present to and seek treatment in primary care. Integrated behavioral health services within this setting can improve access to evidence-based cognitive behavioral therapy (CBT). However, limited information exists on the effectiveness of CBT for depression in primary care.

Cognitive Behavioral Therapy for Anxiety Disorders: Outcomes From a Multi-State, Multi-Site Primary Care Practice.

Background: Anxiety disorders are among the most common mental health conditions. Individuals with anxiety typically seek services in primary, rather than specialty, care. While there is significant evidence supporting the efficacy and effectiveness of cognitive behavioral therapy (CBT) for anxiety disorders, there have been no naturalistic studies reporting anxiety-specific treatment outcomes in primary care.

Initial outcomes of a real-world multi-site primary care psychotherapy program.

Objective: Although anxiety, mood, and adjustment disorders are commonly treated in primary care, little evidence exists regarding psychotherapy outcomes within this setting. The primary objective of this study was to describe outcomes of a large-scale primary care psychotherapy program.

Methods: Patients (N = 2772) participated in cognitive behavioral therapy (CBT) as part of a multi-site primary care program.

An Update on Telepsychiatry and How It Can Leverage Collaborative, Stepped, and Integrated Services to Primary Care.

Introduction: In this era of patient-centered care, telepsychiatry (TP; video or synchronous) provides quality care with outcomes as good as in-person care, facilitates access to care, and leverages a wide range of treatments at a distance.

Method: This conceptual review article explores TP as applied to newer models of care (e.g.

A quality improvement project aimed at adapting primary care to ensure the delivery of evidence-based psychotherapy for adult anxiety.

Primary care patients frequently present with anxiety with prevalence ratios up to 30%. Brief cognitive-behavioural therapy (CBT) has been shown in meta-analytic studies to have a strong effect size in the treatment of anxiety. However, in surveys of anxious primary care patients, nearly 80% indicated that they had not received CBT.

Impact of A National Collaborative Care Initiative for Patients With Depression and Diabetes or Cardiovascular Disease.

(Reprinted with permission from 44 (2017) 77-85).

Patient-Centered Medical Home Membership Is Associated with Decreased Hospital Admissions for Emergency Department Behavioral Health Patients.

The objective was to examine the impact of a multipayer patient-centered medical home (PCMH) on health care utilization for behavioral health patients seen at a tertiary care emergency department (ED). A retrospective health records review was performed for PCMH and non-PCMH patients who presented and received a psychiatric consultation during a 2-year period in the ED of the Mayo Clinic Hospital in Rochester, Minnesota. Univariable and multivariable associations with the outcomes of admission and return visits within 72 hours were evaluated using logistic regression models and summarized with odds ratios (ORs) and 95% confidence intervals (CIs).

Prediction of Primary Care Depression Outcomes at Six Months: Validation of DOC-6 ©.

Background: The goal of this study was to develop and validate an assessment tool for adult primary care patients diagnosed with depression to determine predictive probability of clinical outcomes at 6 months.

Methods: We retrospectively reviewed 3096 adult patients enrolled in collaborative care management (CCM) for depression. Patients enrolled on or before December 31, 2013, served as the training set (n = 2525), whereas those enrolled after that date served as the preliminary validation set (n = 571).

The COMPASS initiative: description of a nationwide collaborative approach to the care of patients with depression and diabetes and/or cardiovascular disease.

Objective: To describe a national effort to disseminate and implement an evidence-based collaborative care management model for patients with both depression and poorly controlled diabetes and/or cardiovascular disease across multiple, real-world diverse clinical practice sites.

Methods: Goals for the initiative were as follows: (1) to improve depression symptoms in 40% of patients, (2) to improve diabetes and hypertension control rates by 20%, (3) to increase provider satisfaction by 20%, (4) to improve patient satisfaction with their care by 20% and (5) to demonstrate cost savings. A Care Management Tracking System was used for collecting clinical care information to create performance measures for quality improvement while also assessing the overall accomplishment of these goals.

Impact of a national collaborative care initiative for patients with depression and diabetes or cardiovascular disease.

Objective: The spread of evidence-based care is an important challenge in healthcare. We evaluated spread of an evidence-based large-scale multisite collaborative care model for patients with depression and diabetes and/or cardiovascular disease (COMPASS).

Methods: Primary care patients with depression and comorbid diabetes or cardiovascular disease were recruited.

Large-Scale Dissemination of Collaborative Care and Implications for Psychiatry.

The evidence is overwhelming that a collaborative care approach to common mental illnesses is superior to usual care. Why isn't this model widely available? The authors of this column argue that the problem is not a lack of evidence or documentation of a better model, but the need for adoption of implementation science and dissemination knowledge to bring collaborative care into practice. They discuss the challenge of providing mental health care in the United States, the evidence that collaborative care is effective and can play a major role in expanding mental health services, the science of dissemination, six successful large-scale dissemination programs for collaborative care, and the implications of this shift in care delivery for psychiatry and all mental health providers.

Treatment outcomes of depression: the pharmacogenomic research network antidepressant medication pharmacogenomic study.

Background: The effectiveness of selective serotonin reuptake inhibitors (SSRIs) in patients with major depressive disorder (MDD) is controversial.

Aims: The clinical outcomes of subjects with nonpsychotic MDD were reported and compared with the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study outcomes to provide guidance on the effectiveness of SSRIs.

Methods: Subjects were treated with citalopram/escitalopram for up to 8 weeks.

Impact of symptom remission on outpatient visits in depressed primary care patients treated with collaborative care management and usual care.

Depression symptoms contribute to significant morbidity and health care utilization. The aim of this study was to determine the impact of symptom improvement (to remission) on outpatient clinical visits by depressed primary care patients. This study was a retrospective chart review analysis of 1733 primary care patients enrolled into collaborative care management (CCM) or usual care (UC) with 6-month follow-up data.

Integration of mental health resources in a primary care setting leads to increased provider satisfaction and patient access.

Objective: This evaluation assessed the opinions and experiences of primary care providers and their support staff before and after implementation of expanded on-site mental health services and related system changes in a primary care clinic.

Method: Individual semistructured interviews, which contained a combination of open-ended questions and rating scales, were used to elicit opinions about mental health services before on-site system and resource changes occurred and repeated following changes that were intended to improve access to on-site mental health care.

Results: In the first set of interviews, prior to expanding mental health services, primary care providers and support staff were generally dissatisfied with the availability and scheduling of on-site mental health care.

Sustaining practice change one year after completion of the national depression management leadership initiative.

Objective: This report describes the sustainability of quality improvement interventions for depression care in psychiatric practice one year after the completion of the National Depression Management Leadership Initiative (NDMLI) in 2006. The main intervention involved continued use of the nine-item depression scale of the Patient Health Questionnaire (PHQ-9) for routine care of patients with depressive disorders.

Methods: One year after project completion, lead psychiatrists from the 17 participating practices were surveyed about the sustainability of key practice interventions and dissemination of the interventions.

Depression remission after six months of collaborative care management: role of initial severity of depression in outcome.

Aim The impact of initial severity of depression on the rate of remission has not been well studied. The hypothesis for this study was that increased depression severity would have an inverse relationship on clinical remission at six months while in collaborative care management. Participants The study cohort was 1128 primary care patients from a south-eastern Minnesota practice and was a longitudinal retrospective chart review analysis.

Patient self-assessment factors predictive of persistent depressive symptoms 6 months after enrollment in collaborative care management.

Background: Collaborative care management (CCM) is effective for improving depression outcomes. However, a subset of patients will still have symptoms after 6 months. This study sought to determine whether routinely obtained baseline clinical, demographic, and self-assessment variables would predict which patients endorse persistent depressive symptoms (PDS) after 6 months.

Age of depressed patient does not affect clinical outcome in collaborative care management.

Clinical response and remission for the treatment of depression has been shown to be improved utilizing collaborative care management (CCM). Prior studies have indicated that the presence of mental health comorbidities noted by self-rated screening tools at the intake for CCM are associated with worsening outcomes; few have examined directly the impact of age on clinical response and remission. The hypothesis was that when controlling for other mental health and demographic variables, the age of the patient at implementation of CCM does not significantly impact clinical outcome, and that CCM shows consistent efficacy across the adult age spectrum.

Depression outcomes in psychiatric clinical practice: using a self-rated measure of depression severity.

Objectives: This study determined rates of response and remission at 12 and 24 weeks among patients being treated by psychiatrists for depression on the basis of Patient Health Questionnaire-9 (PHQ-9) scores and identified factors associated with response and remission.

Methods: Adult patients at 17 psychiatric practices participating in the National Depression Management Leadership Initiative completed the PHQ-9 at every office visit for one year irrespective of severity or chronicity of symptoms or adherence to treatment. Treating psychiatrists recorded the date when formal self-management goals were documented.

Implementation of a care management model for depression at two primary care clinics.

The Mayo clinic participated in the Depression Improvement Across Minnesota, Offering a New Direction model at two Mayo Family Clinics, that is, the Rochester Northwest and Northeast sites. Although the Northwest and Northeast clinics demonstrated the best 6-month remission rates in the state during the first year of implementation, they were retrospectively found to differ on several process issues and on measures related to the populations served. Six-month remission rates were significantly better at Northwest clinic; yet, Northeast clinic had more patient contacts.

Systematic use of patient-rated depression severity monitoring: is it helpful and feasible in clinical psychiatry?

Objective: The gap between evidence-based treatments and routine care has been well established. Findings from the Sequenced Treatments Alternatives to Relieve Depression (STAR*D) emphasized the importance of measurement-based care for the treatment of depression as a key ingredient for achieving response and remission; yet measurement-based care approaches are not commonly used in clinical practice.

Methods: The Nine-Item Patient Health Questionnaire (PHQ-9) for monitoring depression severity was introduced in 19 diverse psychiatric practices.