OBJECTIVE: To compare collaborative care for treatment of depression in primary care with consult-liaison (CL) care. In collaborative
care, a mental health team provided a treatment plan to the primary care provider, telephoned patients to support adherence
to the plan, reviewed treatment results, and suggested modifications to the provider. In CL care, study clinicians informed
the primary care provider of the diagnosis and facilitated referrals to psychiatry residents practicing in the primary care
clinic.
DESIGN: Patients were randomly assigned to treatment model by clinic firm.
SETTING: VA primary care clinic.
PARTICIPANTS: One hundred sixty-eight collaborative care and 186 CL patients who met criteria for major depression and/or dysthymia.
MEASUREMENTS: Hopkins Symptom Checklist (SCL-20), Short Form (SF)-36, Sheehan Disability Scale.
MAIN RESULTS: Collaborative care produced greater improvement than CL in depressive symptomatology from baseline to 3 months (SCL-20 change
scores), but at 9 months there was no significant difference. The intervention increased the proportion of patients receiving
prescriptions and cognitive behavioral therapy. Collaborative care produced significantly greater improvement on the Sheehan
at 3 months. A greater proportion of collaborative care patients exhibited an improvement in SF-36 Mental Component Score
of 5 points or more from baseline to 9 months.
CONCLUSIONS: Collaborative care resulted in more rapid improvement in depression symptomatology, and a more rapid and sustained improvement
in mental health status compared to the more standard model. Mounting evidence indicates that collaboration between primary
care providers and mental health specialists can improve depression treatment and supports the necessary changes in clinic
structure and incentives.
Key words depressive disorder - primary health care - veterans
This report presents the findings and conclusions of the authors. It does not necessarily represent those of the VA or HSR&D
Service.
The Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service supported
this research.