P05 - Navigating Mental Health in Primary Care – It Takes a Village

Depression affects more than 6.5 million Americans ages 65 and over ("Older Adults," 2015). The diagnosis and treatment of late life depression (LLD) is complicated, due to factors such as comorbidities, clinical presentation, adverse drug effects, drug interactions, and psychosocial factors (Lill, 2015). Late-life depression has a profound negative impact on the quality of life. Unutzer et al (2000) found that individuals with clinically significant depressive symptoms at baseline had significantly lower quality adjusted life years (QALYs) over a 4-year study period than non-depressed individuals, even after adjusting for differences in age, gender, and other chronic medical conditions (Unutzer et al., 2000). Since the care of patients with multiple chronic diseases accounts for the majority of healthcare costs, effective approaches to managing such complex care in primary care are needed (Katon et al., 2010). At the same time, implementing and sustaining these interventions in real-world settings has presented significant challenges.

In the absence of collaborative depression care management programs, primary care practices often struggle to balance active chronic disease management with proactive screening for depression and other comorbidities.

A multimodal intervention was developed to facilitate the delivery of an evidence-based collaborative depression care management protocol (DCP) in primary care. Pre- and post-survey design and modified chart review were utilized to assess effectiveness of the intervention. The intervention was delivered to a primary care team comprising primary care providers, triage staff, nursing staff, and clinic billing personnel.
Results suggested 79.06% increase in participants’ self-rated knowledge and 75 % increase in participants’ confidence level regarding primary care of the elderly, identifying signs of LLD, and ability to deliver DCP. The post-intervention depression screening rate was 51.9%, which was significantly higher than the benchmark of 25%.
An evidence-based collaborative DCP model highlights the unique opportunity to provide depression screening and identification in geriatric primary care, thus positively impacting chronic disease management and utilization of healthcare cost in a vulnerable population.