Telephone outreach aids depression screening: intervention encourages medically ill patients to use mental health services in primary care practices.
Such an intervention can be incorporated into primary care as a way to connect at-risk patients with mental health care services.
As part of an ongoing study of mental health care utilization and the cost effectiveness of outreach services, he and his colleagues identified a cohort of medically ill individuals using administrative health care utilization data from a large national employer. Prior studies have shown that medically ill patients often have comorbid mental illness, particularly depression, but are less likely than other patients to use mental health services. It is believed that early detection and treatment of depression could minimize the health and economic costs of the disease.
Of the primary care patients in the study, 104 were assigned using a nonrandomized method to an intervention group and 158 to a control group matched by demographics, medical diagnosis, and prior year medical costs, Dr. Ong said at the annual meeting of the Society of General Internal Medicine.
Patients in the intervention arm were contacted via telephone by outreach counselors who performed behavioral health screening and offered referrals to mental health clinicians, support groups, support services, financial counseling, and legal aid. Preliminary data show that 70% of the patients in the intervention group accepted a referral from the outreach service, and 95% were satisfied with their interaction with that service, he reported.
Specialty mental health utilization increased in the intervention group, rising from no utilization in the year prior to the intervention to 27 users in the year after the intervention. Of the specialty mental health claims, 43% were for depression and 20% were for adjustment disorder. No specialty mental health utilization occurred in either time period for the matched controls, Dr. Ong said.
Overall, primary care provision of mental health services declined after the outreach trial. In the intervention group, mental health service claims declined significantly, from 9% of all claims to 4.4% of all claims, and the number of users declined from 41 to 34. But mental health service claims increased significantly in the control group, from 6.1% of all claims to 8.1% of all claims, and the number of users increased from 29 to 39. The increase in specialty care offset the decrease in primary care mental health services, so there was a net increase in treatment, he said.
The most effective aspect of the outreach program so far "has been the ability of a non--clinic-based approach to increase the number of people getting mental health services," Dr. Ong said. "It's hard to ask primary care physicians to improve their detection of depression and other mental illnesses when they have so many other issues to address with their patients."
The investigators consider the telephone-based outreach to be complementary to current detection systems, he added.
A downside to the service "is that we detect a lot of people at risk for depression, but there is no current way to follow up on contacted individuals who don't engage with treatment after the telephone outreach." Plans for the next stage of the research include developing a protocol for partnering with primary care physicians to facilitate follow-up, he said. The investigators also plan to conduct a randomized control trial to assess the value of integrating outreach services with primary care.
BY DIANA MAHONEY
New England Bureau
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|Title Annotation:||Psychosomatic Medicine|
|Publication:||Clinical Psychiatry News|
|Date:||Nov 1, 2004|
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