Shared Care Collaborative approach for improving the detection, assessment and treatment of depression
Cheryl Washburn, Ph.D, R.Psych., UBC Counselling Services
Patricia Mirwaldt, M.D. CCFP, UBC Student Health Services
Whitney Sedgwick, Ph.D, R.Psych., UBC Counselling Services
UBC Shared Care Collaborative
- community centered collaborative network of primary care providers, working as a multidisciplinary team; enabling sustainable improvement in the primary treatment of depression at UBC and the surrounding community
This workshop will:
- Describe the key features involved in the development and implementation of a shared care collaborative model for the treatment of depression
- Present data reflecting established stretch goals
- Outline some of the challenges and benefits of a shared care collaborative for the treatment of depression
- Discuss the applicability of a shared care model in your respective communities
The UBC Collaborative
Sept/03: position paper
Jun/04: Initial stakeholders meeting
Aug/04: Planning session (i.e. conceptual models)
Oct/04: Funding proposal submitted
March/05: Funding approved
June/05: Planning session (i.e. scope, membership)
Time Line (cont.)
Oct/05: Learning session (i.e. reviewed best practice models)
Nov/05: Planning session (stretch goals)
Jan/06: Learning session part I (Suicide assessment)
March/06: Learning session, part II (Suicide assessment)
March/06: Progress report submitted to VCH
Time Line (cont.)
June, Oct, Dec 06: ongoing: data review and tech. consultations re: data input
March/07: Modification to stretch goals
March/07: Flowsheet revision
Ongoing: Consideration of sustainability post-funding
2004 NCHA Undergraduate student data: Gaps in care
2006 NCHA Graduate student data: Gaps in care
Gaps in care
- Lack of awareness of signs/symptoms, prevention and available resources and services
- Stigma associated with depression and treatments that prevent people from receiving help.
- Failure to comply with treatment.
- Failure to recognize/assess depression, educate patients and families about nature of depression and support self management
- Failure to recommend evidence-based psychotherapy
- Inadequate dosage and duration of meds
- Lack of time and compensation
- Limited access to mental health professionals
- Lack of ongoing monitoring and maintenance of change despite high rates of relapse and recurrence
- Lack of integration among multiple existing primary health care services
Key features of models to address gaps in depression care
Framework for change: The Care Model
Adapted from Glasgow, R., Orleans, C., Wagner, E., Curry, S., Solberg, L. (2001). Does the Chronic Care Model also serve as a
template for improving prevention? The Milbank Quarterly, 79(4), and World Health Organization, Health and Welfare
Canada and Canadian Public Health Association.(1986).Ottawa Charter of Health Promotion.
Framework for Change: Model for ImprovementInstitute for Healthcare Improvement
Implement changes more
Framework for change: Breakthrough Series Learning Model
The UBC Collaborative
Aims of Collaborative
- Improve health outcomes specific to depression
- Develop and implement more effective suicide risk assessment practices
- Facilitate patient self-management skills
- Improve access to treatment for depression for members of the UBC and University neighborhood communities
- Develop the primary healthcare network in the UBC community
BC Provincial Depression Strategy Recommended Approaches (2002)
- Early intervention
- Collaborative care
- Stepped care
- Chronic disease management model
N= 170 (Nov 1, 2006)
- % patients given PHQ-9 (Patient Health Questionnaire) at, or within 10 days of, diagnosis
Stretch goal: 85% Results: 137/170=80.6%
- % patients given second PHQ-9 within 8 weeks of diagnosis
Stretch goal: 85%**Results: 30/137= 21.9%
- % patients given third PHQ-9 within 16 weeks of diagnosis
Stretch goal: 75%** Results: 12/30 = 40%
(** of those who completed initial assessment(s))
- % patients who have completed a PHQ-9 between 6-12 months post-diagnosis
Stretch goal: 50% Results**: 164/170= 96.5%
- % patients with PHQ-9 score reduced to < 5 (or in remission) by 16 weeks
Stretch goal: 50% (of depression register population of patients)
- % patients with PHQ-9 score reduced to <5 (or in remission) within 6-12 months post-diagnosis
Stretch goal: 50%(of depression register population of patients)
Results:** 36/170= 21.2%
**(collapsed over 12 months)
- % patients who had a suicide risk assessment at, or within, 10 days of diagnosis.
Stretch goal: 100%Results = 62.4%
- % patients who had second suicide risk assessment within 8 weeks of diagnosis
Stretch goal: 70% (of those who completed first assessment)
Results: 30/137= 21.9%
- % patients who had shird suicide risk assessment within 6 months of diagnosis
Stretch goal: 50% (of those who completed second assessment)
Results: 12/30 = 40.0%
- % patients who had a self-management goal documented
Stretch goal: 50% Results: 111/170= 65.3%
Additional Stretch Goals:
-A key treatment option:
-detailed referral form and FAQ sheet
-6 week, psychoeducational CBT groups entitled “Mood management”
-positive self-report re: mood (based on 18 groups):
Pre-group PHQ-9 mean score=12.1
Post-group PHQ-9 mean score= 5.9
- Motivation to join
- Time commitment
- Compensation – salaried and fee for service considerations
- Consent Issues:
- Designing an informed consent form considering:
- BC Health
- BC Privacy Commissioner
- UBC Freedom of Information Coordinator
- Group Counseling:
- Who’s patient is this? (physician and/or counselor)
- Counselor acceptance and management of non-students (ex. UBC faculty and staff) in groups.
- “Buy In” - physician and patient (acceptance as valid treatment option)
- Data base:
- Electronic medical records and linkages
- Primary care provider inclusion in registry (ex. Non-MD)
- Data and file management (time, data configuration, flowsheets)
- Physician confidence in guiding patients in self care of depression management
- High attrition with this population including practitioners’ reticence to contact patients who missed last appointment
- Lack of systematic follow-up of patients who have completed care to ensure healthy outcomes
- Patients get better from depression-symptoms recede!!
- Improved education and awareness of community, practitioners and affiliated health care providers.
- Early and accurate diagnosis with step-wise application of evidence based care.
- Sustainable network infrastructure provides improved access to existing resources and increased practitioner capacity.
2006 NCHA Female undergraduate students
2006 NCHA Male undergraduate students
2006 NCHA Male graduate students
2006 NCHA Female graduate students
5. Clear focus on group counseling and improved community access to groups.
6. Self management tools developed and utilized as the cornerstone of care.
7. Shared community of care = healthier campus and community.
In what ways could a shared care model have applicability on your campus?
In what ways would a shared care model apply to other health issues on your campus?
Questions and Feedback
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