Screening, Assessment, and Management of Depression in VA Primary Care Clinics

The Behavioral Health Laboratory

Authors

  • David W. Oslin MD,

    1. Philadelphia VA Medical Center and VISN 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Philadelphia, Pa, USA
    2. Section of Geriatric Psychiatry, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa, USA
    3. Center for the Study of Addictions, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa, USA
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  • Jennifer Ross BA,

    1. Philadelphia VA Medical Center and VISN 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Philadelphia, Pa, USA
    2. Section of Geriatric Psychiatry, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa, USA
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  • Steve Sayers PhD,

    1. Philadelphia VA Medical Center and VISN 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Philadelphia, Pa, USA
    2. Section of Geriatric Psychiatry, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa, USA
    3. Center for the Study of Addictions, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa, USA
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  • John Murphy MD,

    1. Philadelphia VA Medical Center and VISN 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Philadelphia, Pa, USA
    2. Department of Medicine, Division of General Internal Medicine, University of Pennsylvania Health System, Philadelphia, Pa, USA
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  • Vince Kane MSW,

    1. Philadelphia VA Medical Center and VISN 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Philadelphia, Pa, USA
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  • Ira R. Katz MD, PhD

    1. Philadelphia VA Medical Center and VISN 4 Mental Illness Research, Education, and Clinical Center (MIRECC), Philadelphia, Pa, USA
    2. Section of Geriatric Psychiatry, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pa, USA
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  • The authors have no conflicts of interest to report.

Address correspondence and requests for reprints to Dr. Oslin: University of Pennsylvania, 3535 Market Street, Room 3002, Philadelphia, PA 19104 (e-mail: oslin@mail.med.upenn.edu).

Abstract

Objectives: The purpose of this project was to assess the utility and feasibility of a telephone-based systematic clinical assessment service, the Behavioral Health Laboratory (BHL), in the context of primary care. The BHL is a clinical service that provides primary care providers with an assessment and a summary of mental health and substance abuse (MH/SA) symptoms and provides treatment decision support, including triage to specialty MH/SA services. The BHL was implemented to assist in the evaluation of patients who screened positively for depression at an annual clinical appointment or who were identified through routine care.

Methods: Results from systematic screening of primary care patients were extracted during a period of 6 months prior to implementation of the BHL and after implementation of the BHL. Descriptive results of the 580 evaluations conducted during this time were available.

Results: Results suggest an association between the implementation of the BHL and an increase in the proportion of patients screened for depression in primary care. In addition, there was an increase in the proportion of patients who screened positively (2.8% vs 7.0%). The BHL was successful in providing a comprehensive assessment for 78% of those referred. Significant co-occurring mental illness and substance misuse were found among those assessed.

Conclusions: Introducing the BHL into primary care was associated with an apparent change in clinical practice in primary care at the Philadelphia VA Medical Center. Not only were more patients identified, the broad-based approach of the BHL identified significant comorbidity with alcohol misuse, illicit drugs, and suicidal ideation, symptoms likely to have been missed in routine clinical practice. The BHL offers a practical, low-cost method of assessment, monitoring, and treatment planning for patients identified in primary care with MH/SA needs.

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