Collaborative Care for Depression of Adults and Adolescents: Measuring the Effectiveness of Screening and Treatment Uptake

Abstract

Objective: This study analyzes effectiveness of screening, referrals, and treatment uptake of a collaborative care for depression intervention across 10 primary care clinics in Chicago.Methods: Patients were screened with the PHQ-2/9 based on an eligibility algorithm. Electronic health record data were analyzed for sample characteristics, screening rates, referrals, and treatment pathways. To identify disparities, a test of proportions was conducted between eligible and screened patients and referred and treated patients.Results: From November 2016 -December 2017, 25,369 patients were eligible for screening, and rates rose to 79%, versus 7% in the prior year. Screenings, referrals, and uptake occurred proportionately across subgroups except for patients ages 12-17. Adolescent age was associated with disproportionate PHQ-9 screenings and with treatment disengagement. Conclusion:The intervention shows promise in expanding access to care and reducing disparities. Greater access to psychotherapies and innovative treatment modalities, particularly for adolescents, may improve overall treatment uptake.

Paediatric integrated care in the primary care setting: A scoping review of populations served, models used and outcomes measured

“…Cluster randomized trial (Kolko et al, 2014;Yu et al, 2017), crosssectional qualitative (Gouge et al, 2016;Walter et al, 2019) and pilot intervention (Richardson et al, 2009;Thompson et al, 2019) studies each accounted for two articles' designs. A natural experiment (Germán et al, 2017), quasi-experiment (Grimes et al, 2018) and combination survey/retrospective chart review design (Valleley et al, 2020) were used once.…”

“…| RESULTSFigure1details the PRISMA flow diagram for included studies(Tricco et al, 2018). Of the 3019 unique articles identified, 28 fit criteria after conducting full-text analysis(Aupont et al, 2013;Cederna-Meko et al, 2016;Connor et al, 2006;Germán et al, 2017;Gouge et al, 2016;Grimes et al, 2018;Hansel et al, 2017;Hine et al, 2017;Ivanova et al, 2019;Kisely et al, 2006;Kolko et al, 2014;Kolko et al, 2019;Martínez et al, 2018;Moore et al, 2018;Pereira et al, 2021;Pethe et al, 2020;Polaha et al, 2018;Rapp et al, 2017;Richardson et al, 2009;Richardson et al, 2014;Rodríguez et al, 2019;Rousseau et al, 2017;Shippee et al, 2018;Thompson et al, 2019;Valleley et al, 2007;Valleley et al, 2020;Walter et al, 2019;Yu et al, 2017). Five studies addressed provider outcomes and 23 focused on patient access and outcomes.…”

“…Two of the articles included in the final analysis reported on differing outcomes from the same study(Kolko et al, 2014;Yu et al, 2017). Key characteristics and findings of the included articles are described in TableS2.3.1 | Objective 1: Paediatric subpopulations servedThe majority of the clinics were located in urban areas (n = 13)(Cederna-Meko et al, 2016;Germán et al, 2017;Grimes et al, 2018;Ivanova et al, 2019;Moore et al, 2018;Pereira et al, 2021;Pethe et al, 2020;Polaha et al, 2018;Richardson et al, 2009;Richardson et al, 2014;Rodríguez et al, 2019;Thompson et al, 2019;Walter et al, 2019) in the northeastern United States (n = 11)(Aupont et al, 2013;Connor et al, 2006;Germán et al, 2017;Hine et al, 2017;Ivanova et al, 2019;Kolko et al, 2014;Kolko et al, 2019;Pethe et al, 2020;Valleley et al, 2007;Walter et al, 2019;Yu et al, 2017). Three of the studies focused exclusively on rural communities(Gouge et al, 2016;Hansel et al, 2017;Valleley et al, 2007), three included a mix of rural, urban and suburban populations(Hine et al, 2017;Kisely et al, 2006;Valleley et al, 2020), and nine studiesF I G U R E 1 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram outlining scoping review search results…”

“…The sample for five studies included more than 60% females(Martínez et al, 2018;Rapp et al, 2017;Richardson et al, 2009;Richardson et al, 2014;Shippee et al, 2018), and for five studies, more than 60% males(Grimes et al, 2018;Kolko et al, 2014;Moore et al, 2018;Valleley et al, 2007;Yu et al, 2017). Three articles did not specify gender(Pereira et al, 2021;Pethe et al, 2020;Thompson et al, 2019). Two health care provider-focused studies had mostly female providers(Kolko et al, 2019;Rousseau et al, 2017), one had equal distribution of males and females(Kisely et al, 2006), and two did not report on gender(Hine et al, 2017;Rodríguez et al, 2019).Fourteen of the patient-focused studies reported income status of participants.…”

“…Informal training was documented for PCPs in four studies(Cederna-Meko et al, 2016;Moore et al, 2018;Pereira et al, 2021;Rodríguez et al, 2019) and for BHPs in one study(Kolko et al, 2019). Nine model evaluations focused on specific behavioural health diagnoses: ADHD(Moore et al, 2018), depression(Martínez et al, 2018;Rapp et al, 2017;Richardson et al, 2009;Richardson et al, 2014;Shippee et al, 2018;Thompson et al, 2019), ADHD/anxiety(Kolko et al, 2014) and ADHD/depression/anxiety(Aupont et al, 2013).3.3 | Objective 3: PIC outcomes explored and measures and strategies used to assess those outcomesOutcomes from the 28 studies were grouped into categories by one author and then reviewed and discussed by all authors until consensus was reached. The average number of outcomes measured per study was 2.43 (Range: 1-5).…”