Collaborative Care Management Associated With Improved Depression Outcomes in Patients With Personality Disorders, Compared to Usual Primary Care

Abstract

Background: The use of a collaborative care management (CCM) model can dramatically improve short- and long-term treatment outcomes for patients with major depressive disorder (MDD). Patients with comorbid personality disorder (PD) may experience poorer treatment outcomes for MDD. Our study seeks to examine the differences in MDD treatment outcomes for patients with comorbid PD when using a CCM approach rather than usual care (UC). Methods: In our retrospective cohort study, we reviewed the records of 9614 adult patients enrolled in our depression registry with the clinical diagnosis MDD and the diagnosis of PD (Yes/No). Clinical outcomes for depression were measured with Patient Health Questionnaire–9 (PHQ-9) scores at 6 months. Results: In our study cohort, 59.4% of patients (7.1% of which had comorbid PD) were treated with CCM, as compared with 40.6% (6.8% with PD) treated with UC. We found that the presence of a PD adversely affected clinical outcomes of remission within both groups, however, at 6 months patients with PD had significantly lower MDD remission rates when treated with UC as compared with those treated with CCM (11.5% vs 25.2%, P = .002). Patients with PD in the UC group were also noted to have an increased rate of persistent depressive symptoms (PHQ-9 score ≥10) at 6 months as compared with those in the CCM group (67.7% vs 51.7%, P = .004). Conclusions: In patients with comorbid MDD and PD, clinical outcomes at 6 months were significantly improved when treated with CCM compared with UC. This finding is encouraging and supports the idea that CCM is an effective model for caring for patients with behavioral concerns, and it may be of even greater benefit for those patients being treated for comorbid behavioral health conditions.

Early Health System Experiences with Collaborative Care (CoCM) Billing Codes: a Qualitative Study of Leadership and Support Staff

“…Other key CoCM components include treatment to evidence-based targets and the systematic use of a patient registry. The efficacy of CoCM has been demonstrated by more than 80 randomized controlled trials (RCTs) 3 and its core principles have been applied to the treatment of numerous mental health conditions [4][5][6][7][8][9] in a variety of settings 9,10 . However, its non-traditional, teambased workflow (including an emphasis on the time between face-to-face visits) has made reimbursement a major challenge 2 .…”

Depression Outcomes in Smokers and Nonsmokers: Comparison of Collaborative Care Management Versus Usual Care

“…30,31 Prior studies have reviewed the enhanced effectiveness of treatment within CCM and the comparison of CCM with UC. [32][33][34][35][36] We have also shown that comorbid psychiatric and medical conditions can have a negative impact on depression outcomes at 6 months. 35,[37][38][39][40] Recently, we reviewed the electronic records of 2826 depressed patients enrolled in CCM and found that current smokers had an associated decreased treatment adherence and worse clinical outcomes at 6 months compared with non-smokers.…”

“…[32][33][34][35][36] We have also shown that comorbid psychiatric and medical conditions can have a negative impact on depression outcomes at 6 months. 35,[37][38][39][40] Recently, we reviewed the electronic records of 2826 depressed patients enrolled in CCM and found that current smokers had an associated decreased treatment adherence and worse clinical outcomes at 6 months compared with non-smokers. 41 Therefore, we sought to evaluate whether a current smoking history had a negative impact on depression treatment of adult primary care patients in the context of treatment with UC versus treatment with CCM.…”