Current Position Information
Physician, Rochester Regional Health, Rochester, New York
Scholarly Research Project
Implementing Collaborative Care for Depression in a Residency Clinic Population
Liam P. Burke, MD; Stephanie Richards, MD; Makenzie Zidek, BS; Phillip Phelps, LCSW; Benjamin Skinker, MD; Nikiha Robinson, LCSW.
Department of Family Medicine, UPMC Shadyside, Pittsburgh, Pennsylvania
Every year 6.7% of Americans experience depression, 30% of whom receive adequate treatment in primary care. The collaborative care (CC) model has been shown to improve depressed populations by facilitating patient contact and timeliness of medication changes as well as behavioral activation.
A retrospective chart review of our family medicine residency population identified 117 depressed patients by diagnosis codes. Their PHQ-9 scores, frequency of contact and referral rates to the faculty psychiatrist were documented and compared to the intervention group that received care management (CM) with a grant-funded AmeriCorps member for up to 6 months. The intervention group of 82 depressed patients received telephonic CM to ascertain treatment plan adherence and behavioral activation (BA) counseling. A registry of CM data was regularly reviewed by a psychiatrist and treatment recommendations were made to PCP electronically.
The intervention included patients with PHQ-9 scores >9 with or without comorbid anxiety disorders and excluded those with co-morbid bipolar, schizophrenia and substance abuse. In the CM cohort, clinical patient contact increased nearly four-fold and referrals to faculty psychiatrist reduced by 47%. Primary outcome of >50% reduction in PHQ-9 scores was equal between standard care and CM groups. However, intervention analysis was limited by a number of factors.
CM of patients in a residency clinic has moderately improved markers of effective care in our depressed population. These successes have lead us to conclude that pursuing future funding and stewardship of CM within our residency practice should be continued.