Abstract
OBJECTIVES: The purpose of this project was to assess the utility and feasibility of a telephone-based systematic clinical assessment service, the Behavioral Health Laboratory (BHL), in the context of primary care. The BHL is a clinical service that provides primary care providers with an assessment and a summary of mental health and substance abuse (MH/SA) symptoms and provides treatment decision support, including triage to specialty MH/SA services. The BHL was implemented to assist in the evaluation of patients who screened positively for depression at an annual clinical appointment or who were identified through routine care.
METHODS: Results from systematic screening of primary care patients were extracted during a period of 6 months prior to implementation of the BHL and after implementation of the BHL. Descriptive results of the 580 evaluations conducted during this time were available.
RESULTS: Results suggest an association between the implementation of the BHL and an increase in the proportion of patients screened for depression in primary care. In addition, there was an increase in the proportion of patients who screened positively (2.8% vs 7.0%). The BHL was successful in providing a comprehensive assessment for 78% of those referred. Significant co-occurring mental illness and substance misuse were found among those assessed.
CONCLUSIONS: Introducing the BHL into primary care was associated with an apparent change in clinical practice in primary care at the Philadelphia VA Medical Center. Not only were more patients identified, the broad-based approach of the BHL identified significant comorbidity with alcohol misuse, illicit drugs, and suicidal ideation, symptoms likely to have been missed in routine clinical practice. The BHL offers a practical, low-cost method of assessment, monitoring, and treatment planning for patients identified in primary care with MH/SA needs.
Similar content being viewed by others
References
Agency for Healthcare Research and Quality. U.S. Preventive Services Task Force Now Finds Sufficient Evidence to Recommend Screening Adults for Depression. Rockville, Md: Agency for Healthcare Research and Quality; 2002.
Frisher M, Collins J, Millson D, Crome I, Croft P. Prevalence of comorbid psychiatric illness and substance misuse in primary care in England and Wales. J Epidemiol Community Health. 2004;58:1036–41.
Bruce ML, Ten Have TR, Reynolds III CF, et al. Reducing suicidal ideation and depressive symptoms in depressed older primary care patients: a randomized controlled trial. JAMA. 2004;291:1081–91.
Levkoff SE, Chen H, Coakley E, et al. Design and sample characteristics of the PRISM-E multisite randomized trial to improve behavioral health care for the elderly. J Aging Health. 2004;16:3–27.
Unutzer J, Katon W, Callahan CM, et al. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA. 2002;288:2836–45.
Simon GE, Von Korff M, Ludman EJ, et al. Cost-effectiveness of a program to prevent depression relapse in primary care. Med Care. 2002;40:941–50.
Simon GE, Katon WJ, VonKorff M, et al. Cost-effectiveness of a collaborative care program for primary care patients with persistent depression. Am J Psychiatry. 2001;158:1638–44.
Oslin DW, Sayers S, Ross J, et al. Disease management for depression and at-risk drinking via telephone in an older population of veterans. Psychosom Med. 2003;65:931–7.
Department of Veterans Affairs. FY2002 end of year network performance measure report, 2002.
Blessed G, Tominson BE, Roth M. The association between quantitative measures of dementia and of senile change in the cerebral gray matter. Br J Psychiatry. 1968;114:797–811.
Sheehan DV, Lecrubier Y, Sheehan K, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(suppl 20):22–33.
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Internal Med. 2001;16:606–13.
Sobell L, Sobell M, Gloria L, Cancilla A. Reliability of a timeline method: assessing normal drinkers’ reports of recent drinking and a comparative evaluation across several populations. Br J Addiction. 1988;83:393–402.
Paykel ES, Myers JK, Lindenthal JJ, Tanner J. Suicidal feelings in the general population: a prevalence study. Br J Psychiatry. 1974;124:460–9.
Bartels SJ, Coakley E, Oxman TE, et al. Suicidal and death ideation in older primary care patients with depression, anxiety, and at-risk alcohol use. Am J Geriatric Psychiatry. 2002;10:417–27.
Ware J, Kossinski M, Keller S. How to score the SF-12 (R) pyshical and mental health summary scales. 3rd edn. Lincoln, RI: QualityMetric Incorporated; 1998.
Food and Drug Administration. Worsening depression and suicidality in patients being treated with antidepressant medications, 2004.
Department of Veterans Affairs. Unique SSN’s with a Dx of depression in FY 2004 followed by primary care and/or mental health clinics, 2004.
Wells KB, Sherbourne C, Schoenbaum M, et al. Impact of disseminating quality improvement programs for depression in managed primary care: a randomized controlled trial. JAMA. 2000;283:212–20.
Revicki DA, Tohen M, Gyulai L, et al. Telephone versus in-person clinical and health status assessment interviews in patients with bipolar disorder. Harv Rev Psychiatry. 1997;5:75–81.
Williams S, Crouch R, Dale J. Providing health-care advice by telephone. Prof Nurse. 1995;10:750–2.
Kawas C, Karagiozis H, Resau L, Corrada M, Brookmeyer R. Reliability of the blessed telephone information-memory-concentration test. J Geriatr Psychiatry Neurol. 1995;8:238–42.
Greist JH, Jefferson JW, Wenzel KW, et al. The telephone assessment program: efficient patient monitoring and clinician feedback. MD Comput. 1997;14:382–7.
Sobell LC, Brown J, Leo GI, Sobell MB. The reliability of the alcohol timeline followback when administered by telephone and by computer. Drug Alcohol Depend. 1996;42:49–54.
Rohde P, Lewinsohn PM, Seeley JR. Comparability of telephone and face-to-face interviews in assessing axis I and II disorders. Am J Psychiatry. 1997;154:1593–8.
Coon GM, Pena D, Illich PA. Self-efficacy and substance abuse: assessment using a brief phone interview. J Subst Abuse Treat. 1998;15:385–91.
Simon GE, Revicki D, VonKorff M. Telephone assessment of depression severity. J Psychiatric Res. 1993;27:247–52.
Simpson J, Doze S, Urness D, Hailey D, Jacobs P. Telepsychiatry as a routine service—the perspective of the patient. J Telemed Telecare. 2001;7:155–60.
Pulier ML, Ciccone DS, Castellano C, Marcus K, Schleifer SJ. Medical versus nonmedical mental health referral: clinical decision-making by telephone access center staff. J Behav Health Serv Res. 2003;30:444–51.
Gatz M, Reynolds CA, John R, Johansson B, Mortimer JA, Pedersen NL. Telephone screening to identify potential dementia cases in a population-based sample of older adults. Int Psychogeriatr. 2002;14:273–89.
Author information
Authors and Affiliations
Corresponding author
Additional information
The authors have no conflicts of interest to report.
This work was supported, in part, by a grant from the National Institute of Mental Health K08MH01599 & P30 MH66270, National Institute of Alcohol Abuse and Alcoholism R01, Department of Veterans Affairs HSRD Investigator Initiated Research IIR 02-108, and the Mental Illness Research, Education, and Clinical Center (MIRECC) at the Philadelphia VAMC. The success of the BHL would not be possible without the dedication of the primary care staff at the Philadelphia VAMC. The staff clearly values the integration of behavioral health in the daily routine of primary care. We also want to acknowledge the help of Joyce Askew who was invaluable in developing the depression clinical reminder for the electronic record and extracting data from the electronic record.
Rights and permissions
About this article
Cite this article
Oslin, D.W., Ross, J., Sayers, S. et al. Screening, assessment, and management of depression in VA primary care clinics. J GEN INTERN MED 21, 46–50 (2006). https://doi.org/10.1111/j.1525-1497.2005.0267.x
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1111/j.1525-1497.2005.0267.x