Steps for Implementing Collaborative Care Programs for Depression

Abstract

Numerous studies have demonstrated that collaborative care (care management) for depression improves outcomes, yet few clinics have implemented this evidence-based practice. To promote adoption of this best practice, our objective was to describe the steps needed to tailor collaborative care models for local needs, resources, and priorities while maintaining fidelity to the evidence base. Based on lessons learned from 2 multisite Veterans Affairs implementation studies conducted in 2 different clinical, organizational, and geographic contexts, we describe in detail the steps needed to adapt an evidence-based collaborative care program for depression for local context while maintaining highly fidelity to the research evidence. These steps represent a detailed checklist of decisions and action items that can be used as a tool to plan the implementation of a collaborative care model for depression. We also identify other tools (eg, decision support systems, suicide risk assessment) and resources (eg, training materials) that will support implementation efforts. These implementation tools should help clinicians and administrators develop informed strategies for rolling out collaborative care models for depression.

Outcomes of a Partnered Facilitation Strategy to Implement Primary Care–Mental Health

“…These periods were determined by completion of the implementation plan. 18 Evaluation periods for non-IF sites were the same as their matched IF sites.…”

“…The design phase concluded with a comprehensive implementation plan. 18 During early PC-MHI program implementation, facilitators continued to partner with stakeholders to help sites implement and refine their plans, assess and address barriers, and monitor progress, providing the findings to each site and PC-MHI provider (audit and feedback). Audit and feedback included documenting the completion of activities identified in a site's implementation plan and monitoring use of the 534 clinic code and PC-MHI program fidelity.…”

“…16 We developed an IF strategy in collaboration with the Department of Veterans Affairs' (VA) regional mental health and primary care leadership that addresses these challenges. We served as consultants, providing implementation science expertise, 6,17 tools 18 and resources 19 needed to support implementation. VA regional and facility leadership provided expertise in their organizational structures and clinical processes, and identified typical implementation facilitators and barriers within their network.…”

Predictors of Depression Screening Rates of Nurses Receiving a Personal Digital Assistant-based Reminder to Screen

“…[30][31][32] These initiatives and others have considered the promising role of clinical decision support systems (CDSSs) in improving depression screening and management. 33,34 For example, a small trial compared symptom reduction in patients treated by physicians using a clinical decision support system based upon the Texas Medication Algorithm Project as compared to usual care. 34 Another study examined whether feedback and treatment advice for depression presented to primary care physicians via an electronic health record improved clinical outcomes and care processes for patients with major depression.…”

Feasibility and Impact of Telemonitor-Based Depression Care Management for Geriatric Homecare Patients

“…[13][14][15]33 This individual coordinates depression care among the patient, the physician, and when needed, a mental health specialist. Key components include symptom assessment, treatment evaluation, patient education, and behavioral activation.…”