Effectiveness of Collaborative Care Depression Treatment in Veterans' Affairs Primary Care

Authors

  • Susan C. Hedrick PhD,

    Corresponding author
    1. Received from the Health Services Research and Development Center of Excellence (SCH, C-FL, SDF), and Mental Health Service (EFC, BF, DG), the VA Puget Sound Health Care System, Seattle, Wash; the Departments of Health Services (SCH, C-FL, NH, SDF), Psychiatry and Behavioral Sciences (EFC, DG, BF, WK), and Biostatistics, (PH), University of Washington, Seattle, Wash; Medical Service, VA Puget Sound and the Department of Medicine, University of Washington (SDF, GP), Seattle, Wash; Social Work, VA Puget Sound and the School of Social Work, University of Washington (JB, RB), Seattle, Wash.
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  • Edmund F. Chaney PhD,

    1. Received from the Health Services Research and Development Center of Excellence (SCH, C-FL, SDF), and Mental Health Service (EFC, BF, DG), the VA Puget Sound Health Care System, Seattle, Wash; the Departments of Health Services (SCH, C-FL, NH, SDF), Psychiatry and Behavioral Sciences (EFC, DG, BF, WK), and Biostatistics, (PH), University of Washington, Seattle, Wash; Medical Service, VA Puget Sound and the Department of Medicine, University of Washington (SDF, GP), Seattle, Wash; Social Work, VA Puget Sound and the School of Social Work, University of Washington (JB, RB), Seattle, Wash.
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  • Bradford Felker MD,

    1. Received from the Health Services Research and Development Center of Excellence (SCH, C-FL, SDF), and Mental Health Service (EFC, BF, DG), the VA Puget Sound Health Care System, Seattle, Wash; the Departments of Health Services (SCH, C-FL, NH, SDF), Psychiatry and Behavioral Sciences (EFC, DG, BF, WK), and Biostatistics, (PH), University of Washington, Seattle, Wash; Medical Service, VA Puget Sound and the Department of Medicine, University of Washington (SDF, GP), Seattle, Wash; Social Work, VA Puget Sound and the School of Social Work, University of Washington (JB, RB), Seattle, Wash.
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  • Chuan-Fen Liu PhD,

    1. Received from the Health Services Research and Development Center of Excellence (SCH, C-FL, SDF), and Mental Health Service (EFC, BF, DG), the VA Puget Sound Health Care System, Seattle, Wash; the Departments of Health Services (SCH, C-FL, NH, SDF), Psychiatry and Behavioral Sciences (EFC, DG, BF, WK), and Biostatistics, (PH), University of Washington, Seattle, Wash; Medical Service, VA Puget Sound and the Department of Medicine, University of Washington (SDF, GP), Seattle, Wash; Social Work, VA Puget Sound and the School of Social Work, University of Washington (JB, RB), Seattle, Wash.
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  • Nicole Hasenberg MPH,

    1. Received from the Health Services Research and Development Center of Excellence (SCH, C-FL, SDF), and Mental Health Service (EFC, BF, DG), the VA Puget Sound Health Care System, Seattle, Wash; the Departments of Health Services (SCH, C-FL, NH, SDF), Psychiatry and Behavioral Sciences (EFC, DG, BF, WK), and Biostatistics, (PH), University of Washington, Seattle, Wash; Medical Service, VA Puget Sound and the Department of Medicine, University of Washington (SDF, GP), Seattle, Wash; Social Work, VA Puget Sound and the School of Social Work, University of Washington (JB, RB), Seattle, Wash.
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  • Patrick Heagerty PhD,

    1. Received from the Health Services Research and Development Center of Excellence (SCH, C-FL, SDF), and Mental Health Service (EFC, BF, DG), the VA Puget Sound Health Care System, Seattle, Wash; the Departments of Health Services (SCH, C-FL, NH, SDF), Psychiatry and Behavioral Sciences (EFC, DG, BF, WK), and Biostatistics, (PH), University of Washington, Seattle, Wash; Medical Service, VA Puget Sound and the Department of Medicine, University of Washington (SDF, GP), Seattle, Wash; Social Work, VA Puget Sound and the School of Social Work, University of Washington (JB, RB), Seattle, Wash.
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  • Jan Buchanan MSW, MC,

    1. Received from the Health Services Research and Development Center of Excellence (SCH, C-FL, SDF), and Mental Health Service (EFC, BF, DG), the VA Puget Sound Health Care System, Seattle, Wash; the Departments of Health Services (SCH, C-FL, NH, SDF), Psychiatry and Behavioral Sciences (EFC, DG, BF, WK), and Biostatistics, (PH), University of Washington, Seattle, Wash; Medical Service, VA Puget Sound and the Department of Medicine, University of Washington (SDF, GP), Seattle, Wash; Social Work, VA Puget Sound and the School of Social Work, University of Washington (JB, RB), Seattle, Wash.
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  • Rocco Bagala ACSW,

    1. Received from the Health Services Research and Development Center of Excellence (SCH, C-FL, SDF), and Mental Health Service (EFC, BF, DG), the VA Puget Sound Health Care System, Seattle, Wash; the Departments of Health Services (SCH, C-FL, NH, SDF), Psychiatry and Behavioral Sciences (EFC, DG, BF, WK), and Biostatistics, (PH), University of Washington, Seattle, Wash; Medical Service, VA Puget Sound and the Department of Medicine, University of Washington (SDF, GP), Seattle, Wash; Social Work, VA Puget Sound and the School of Social Work, University of Washington (JB, RB), Seattle, Wash.
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  • Diane Greenberg PhD,

    1. Received from the Health Services Research and Development Center of Excellence (SCH, C-FL, SDF), and Mental Health Service (EFC, BF, DG), the VA Puget Sound Health Care System, Seattle, Wash; the Departments of Health Services (SCH, C-FL, NH, SDF), Psychiatry and Behavioral Sciences (EFC, DG, BF, WK), and Biostatistics, (PH), University of Washington, Seattle, Wash; Medical Service, VA Puget Sound and the Department of Medicine, University of Washington (SDF, GP), Seattle, Wash; Social Work, VA Puget Sound and the School of Social Work, University of Washington (JB, RB), Seattle, Wash.
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  • Grady Paden MD,

    1. Received from the Health Services Research and Development Center of Excellence (SCH, C-FL, SDF), and Mental Health Service (EFC, BF, DG), the VA Puget Sound Health Care System, Seattle, Wash; the Departments of Health Services (SCH, C-FL, NH, SDF), Psychiatry and Behavioral Sciences (EFC, DG, BF, WK), and Biostatistics, (PH), University of Washington, Seattle, Wash; Medical Service, VA Puget Sound and the Department of Medicine, University of Washington (SDF, GP), Seattle, Wash; Social Work, VA Puget Sound and the School of Social Work, University of Washington (JB, RB), Seattle, Wash.
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  • Stephan D. Fihn MD, MPH,

    1. Received from the Health Services Research and Development Center of Excellence (SCH, C-FL, SDF), and Mental Health Service (EFC, BF, DG), the VA Puget Sound Health Care System, Seattle, Wash; the Departments of Health Services (SCH, C-FL, NH, SDF), Psychiatry and Behavioral Sciences (EFC, DG, BF, WK), and Biostatistics, (PH), University of Washington, Seattle, Wash; Medical Service, VA Puget Sound and the Department of Medicine, University of Washington (SDF, GP), Seattle, Wash; Social Work, VA Puget Sound and the School of Social Work, University of Washington (JB, RB), Seattle, Wash.
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  • Wayne Katon MD

    1. Received from the Health Services Research and Development Center of Excellence (SCH, C-FL, SDF), and Mental Health Service (EFC, BF, DG), the VA Puget Sound Health Care System, Seattle, Wash; the Departments of Health Services (SCH, C-FL, NH, SDF), Psychiatry and Behavioral Sciences (EFC, DG, BF, WK), and Biostatistics, (PH), University of Washington, Seattle, Wash; Medical Service, VA Puget Sound and the Department of Medicine, University of Washington (SDF, GP), Seattle, Wash; Social Work, VA Puget Sound and the School of Social Work, University of Washington (JB, RB), Seattle, Wash.
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Address correspondence and requests for reprints to Dr. Hedrick: HSR&D (152) VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA 98108 (e-mail: susan.hedrick@med.va.gov).

Abstract

OBJECTIVE: To compare collaborative care for treatment of depression in primary care with consult-liaison (CL) care. In collaborative care, a mental health team provided a treatment plan to the primary care provider, telephoned patients to support adherence to the plan, reviewed treatment results, and suggested modifications to the provider. In CL care, study clinicians informed the primary care provider of the diagnosis and facilitated referrals to psychiatry residents practicing in the primary care clinic.

DESIGN: Patients were randomly assigned to treatment model by clinic firm.

SETTING: VA primary care clinic.

PARTICIPANTS: One hundred sixty-eight collaborative care and 186 CL patients who met criteria for major depression and/or dysthymia.

MEASUREMENTS: Hopkins Symptom Checklist (SCL-20), Short Form (SF)-36, Sheehan Disability Scale.

MAIN RESULTS: Collaborative care produced greater improvement than CL in depressive symptomatology from baseline to 3 months (SCL-20 change scores), but at 9 months there was no significant difference. The intervention increased the proportion of patients receiving prescriptions and cognitive behavioral therapy. Collaborative care produced significantly greater improvement on the Sheehan at 3 months. A greater proportion of collaborative care patients exhibited an improvement in SF-36 Mental Component Score of 5 points or more from baseline to 9 months.

CONCLUSIONS: Collaborative care resulted in more rapid improvement in depression symptomatology, and a more rapid and sustained improvement in mental health status compared to the more standard model. Mounting evidence indicates that collaboration between primary care providers and mental health specialists can improve depression treatment and supports the necessary changes in clinic structure and incentives.

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