Primary care mental health integration to improve early treatment engagement for veterans who screen positive for depression

IF 3.1 2区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Services Research Pub Date : 2024-08-21 DOI:10.1111/1475-6773.14354

Lucinda B. Leung MD, PhD, MPH, Karen Chu MS, Danielle E. Rose PhD, Susan E. Stockdale PhD, Edward P. Post MD, PhD, Jennifer S. Funderburk PhD, Lisa V. Rubenstein MD, MSPH

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Abstract

Objective

To examine the relationship between the penetration (or reach) of a national program aiming to integrate mental health clinicians into all primary care clinics (PC-MHI) and rates of guideline-concordant follow-up and treatment among clinic patients newly identified with depression in the Veterans Health Administration (VA).

Data Sources/Study Setting

15,155 screen-positive patients 607,730 patients with 2-item Patient Health Questionnaire scores in 82 primary care clinics, 2015–2019.

Study Design

In this retrospective cohort study, we used established depression care quality measures to assess primary care patients who (a) newly screened positive (score ≥3) and (b) were identified with depression by clinicians via diagnosis and/or medication (n = 15,155; 15,650 patient-years). Timely follow-up included ≥3 mental health, ≥3 psychotherapy, or ≥3 primary care visits for depression. Minimally appropriate treatment included ≥4 mental health visits, ≥3 psychotherapy, or ≥60 days of medication. In multivariate regressions, we examined whether higher rates of PC-MHI penetration in clinic (proportion of total primary care patients in a clinic who saw any PC-MHI clinician) were associated with greater depression care quality among cohort patients, adjusting for year, healthcare system, and patient and clinic characteristics.

Data Collection/Extraction Methods

Electronic health record data from 82 VA clinics across three states.

Principal Findings

A median of 9% of all primary care patients were seen by any PC-MHI clinician annually. In fully adjusted models, greater PC-MHI penetration was associated with timely depression follow-up within 84 days (∆P = 0.5; SE = 0.1; p < 0.001) and 180 days (∆P = 0.3; SE = 0.1; p = 0.01) of a positive depression screen. Completion of at least minimal treatment within 12 months was high (77%), on average, and not associated with PC-MHI penetration.

Conclusions

Greater PC-MHI program penetration was associated with early depression treatment engagement at 84−/180-days among clinic patients newly identified with depression, with no effect on already high rates of completion of minimally sufficient treatment within the year.

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整合基层医疗机构的心理健康服务，提高抑郁症筛查呈阳性的退伍军人的早期治疗参与度。

目的研究旨在将心理健康临床医生纳入所有初级保健诊所（PC-MHI）的国家计划的渗透率（或覆盖率）与退伍军人健康管理局（VA）新发现的抑郁症患者的指南一致性随访和治疗率之间的关系：2015-2019年，82家初级保健诊所的15155名筛查阳性患者607730名患者的2项患者健康问卷得分：在这项回顾性队列研究中，我们使用已建立的抑郁症护理质量测量方法来评估（a）新筛查阳性（得分≥3）和（b）临床医生通过诊断和/或药物治疗确定为抑郁症的初级保健患者（n = 15,155; 15,650 患者年）。及时随访包括≥3 次心理健康随访、≥3 次心理治疗随访或≥3 次抑郁症初级保健随访。最低限度的适当治疗包括≥4次精神健康检查、≥3次心理治疗或≥60天的药物治疗。在多变量回归中，我们考察了诊所中PC-MHI渗透率越高（诊所中看过任何PC-MHI临床医生的全科患者比例）是否与队列患者中抑郁症护理质量越高有关，并对年份、医疗保健系统、患者和诊所特征进行了调整：数据收集/提取方法：来自三个州 82 家退伍军人诊所的电子健康记录数据：在所有初级保健患者中，每年接受 PC-MHI 诊疗的患者中位数为 9%。在完全调整模型中，PC-MHI 普及率越高，84 天内抑郁症的及时随访率就越高（∆P = 0.5; SE = 0.1; p 结论：PC-MHI 计划普及率越高，抑郁症的随访率就越高（∆P = 0.5; SE = 0.1; pPC-MHI项目的普及率越高，新发现的抑郁症门诊患者在84天/180天内尽早接受抑郁症治疗的可能性就越大，而对一年内完成最低限度治疗的高比率则没有影响。

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来源期刊

Health Services Research 医学-卫生保健

CiteScore

4.80

自引率

5.90%

发文量

193

审稿时长

4-8 weeks

期刊介绍： Health Services Research (HSR) is a peer-reviewed scholarly journal that provides researchers and public and private policymakers with the latest research findings, methods, and concepts related to the financing, organization, delivery, evaluation, and outcomes of health services. Rated as one of the top journals in the fields of health policy and services and health care administration, HSR publishes outstanding articles reporting the findings of original investigations that expand knowledge and understanding of the wide-ranging field of health care and that will help to improve the health of individuals and communities.