New primary care models target depression

Nearly 17 percent of people will have a major depressive disorder during their lifetimes, according to 2007 data from the National Comorbidity Survey of mental health disorders, reported Kaiser Health News. And while depression is a behavioral-health issue, the illness has far-reaching implications into patients' overall health, as sufferers may take poor care of themselves or have trouble remaining compliant with physicians' instructions.

For these and other reasons, Medicare in October began covering an annual depression screening, with no cost-sharing for beneficiaries. Before the change, primary care doctors may have not made screening for depression in the elderly as much of a priority, the article noted, because such patients often have a number of other chronic conditions that require much of the physicians' time.

But screening for depression can be efficient in the primary care setting, using a tool called the patient health questionnaire or PHQ-9, which asks patients a series of questions in just a few minutes to identify depression and its severity nearly 90 percent of the time.

Experts say the collaborative care model has the most promise for addressing depression in primary care, KHN noted. In one trial conducted at 14 primary care clinics in Washington state, for example, the clinics saved about $600 per patient over two years by having patients who had poorly controlled diabetes and/or heart disease, plus depression, work with a nurse--who collaborated closely with a psychiatrist, PCP, and psychologist--to track their progress and adjust medications as necessary.

But although increased prevalence of the medical home model may make such collaboration more commonplace, it's not widely accessible to patients now.

Another approach, which the Lund Report says is catching on in Oregon, is that of embedding mental health workers within primary care clinics. As part of an effort initially funded by a 2006 grant from the Health Resources and Health Management Administration, a joint arrangement between a local managed care plan and ADAPT, a substance-abuse nonprofit, has allowed patients at the Harvard Medical Park primary care office to be seen by a licensed clinical social worker on site. Among the patients who followed up with a social worker more than five times, utilization, including hospital visits, decreased by 30 percent, according to the Lund Report. Since that success, other managed care plans and practices have launched similar partnerships with ADAPT.

To learn more:
- read the article from Kaiser Health News
- see the story from the Lund Report