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Depression Care Management—an Evidence-Based, Collaborative Care Approach to Treating Depression in a Primary Care Setting


Alisa Aunskul, MSHCM; Daniel Hackett, MD; Karen Coleman, PhD; Mark Dreskin, MD


Abstracts from the Kaiser Permanente 2018 National Quality Conference

From Southern California, Washington

Background: Depression affects more than 16 million American adults each year, leading to disrupted interpersonal relationships, substance abuse, substantial losses in productivity, and a 50% to 100% increase in total health care costs. However, as few as 25% of people with depression receive effective treatment. Most depression is detected in primary care, yet rates of appropriate treatment for patients with a diagnosis remain low. Depression Care Management (DCM) consists of a dedicated team that specializes in the treatment of depression in a primary care setting.
Methods: Population: Adult members age 18 years and older with a depression diagnosis (Major Depression Diagnosis or dysthymia), Patient Health Questionnaire-9 (PHQ-9) score 5-19, with or without a medication. Patients with a PHQ-9 score > 20 can be seen by DCM if a specialist believes s/he can treat the patient safely and effectively. Intervention: Behavioral activation, mindfulness, problem-solving treatment, cognitive behavioral therapy, medication treatment, adherence, and management. Outcome measures: Remission and improvement rates for patients enrolled and in treatment with DCM for a minimum of 3 months with an enrollment PHQ-9 score > 10. Rates are based on changes in PHQ-9 scores.
Results: 1) Increased PHQ-9 rates in Primary Care; 2) increased referral rates to Depression Care Management; 3) treatment outcome targets exceeded: 59% improvement in symptoms (goal 50%) and 44% remission of symptoms (goal 25%).
Discussion: 1) DCM to identify expansion plans for the upcoming year. Plans range from expansion to specialty departments (Obstetrics, Oncology) to further involvement and integration with existing population care management programs such as diabetes; 2) auto-referral pilot to assist with streamlining the process of patients being referred to DCM; 3) develop directional strategy for outreach and monitor penetration rates of DCM program to determine if the right people are getting the right treatment; 4) provide Depression Emmi (Wolters-Kluwer, Chicago, IL) for newly diagnosed patients on online personal action plan; 5) booster sessions and trainings for grief, subsyndromal situational depression, substance use/misuse; 6) Southern California Region participation in Project Chamai.

Abstracts from the Kaiser Permanente 2018 National Quality Conference


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