Group applies interdepartmental approach to depression treatment

Group applies interdepartmental approach to depression treatment
(May 2009 Issue)

By Jennifer Chase Esposito

A Massachusetts organization is applying a multi-pronged approach to treating patients with newly diagnosed depression that is generating unusual results. People are sticking with their treatment, because it's starting with their primary care physician.

The Cambridge Health Alliance (CHA) is a healthcare-providing system comprising three hospital campuses, networked specialty and primary care practices, Cambridge's Public Health Department and the Network Health plan.

In 2007, it assembled its Interdisciplinary Team to improve the care quality for patients with newly diagnosed depression by ensuring that patients who had been both diagnosed with depression and prescribed antidepressant medication had three contacts with their care teams during the 12-week acute phase of treatment.

Through the CHA Interdisciplinary Team - which incorporates staff from the ambulatory, psychiatry, quality and nursing departments - primary care physicians within the CHA network are reaping the benefits of in-house courses on depression detection and immediate access to psychologists, through an innovative program that bridges the gap between doctors who treat bodies and those who treat minds.

"One of the things the program is predicated upon is that there's a whole lot of depression in the community...and there's a lot of evidence that most patients don't want to see a mental health person, but the vast majority of them might accept care from their primary care physician," says Robert Joseph, M.D., M.S., the director of Consultation-Liaison Psychiatry and Primary Care Behavioral Health at CHA.

According to Carleen Riselli, RN, MSN, APRN-BC an adult psychiatric clinical nurse specialist with CHA and the program's primary care depression management program coordinator, some research shows that 40 percent of people in the early stages of depression treatment don't make it to subsequent treatment sessions if they are sent to a second location after diagnosis. For them, dealing with their new illness, developing a relationship with a therapist and juggling the appointments that couple treatment is often too much and leaves many without the care they need because they don't want to go from place to place. With their services in one place, patients can enjoy near one-stop healthcare.

"The whole concept of integrated services in primary care is pretty novel," says Riselli. "It's very patient-centered: People want to get their mental health care in a physical location where they're comfortable.

"There are so many stigmas with mental health care [that] I also think that it keeps people in care longer," she adds.

Among the elements of the Interdisciplinary Team program was the development of a primary care depression toolkit; a sophisticated data report to monitor care; training sessions on depression management for nurses, physicians and other care team members which Riselli helps to coordinate; and readily available psychiatric consultation. The results have been significant: The percentage of patients receiving the recommended three contacts is between 20 to 25 percent, which has more than tripled since the program's implementation.

While the program is designed to help primary care practitioners to detect symptoms, it doesn't obviate the need for conventional mental health care and still allows for consultation referrals or care with specific mental health providers.

"This is a program that appeals partly to people who are not well cultivated in Western culture," says Joseph. "In Cambridge, we have a big immigrant population, many of whom are poor and disenfranchised and are less likely to access conventional mental health care. [This program] expands access to care for a broader group by providing important care that's really helpful for our population."

In February, the CHA's Interdisciplinary Team was honored for "improving the care of patients with depression" with the 2008 H. Richard Nesson Award for Excellence, from Partners Community Healthcare, Inc.