Implementation of perinatal collaborative care: a health services approach to perinatal depression care.

Emily S. Miller,Eydie L. Moses-Kolko,Lauren M. Osborne,Katherine McEvoy,Nancy Grote,M. Camille Hoffman,Rebekah Jensen

doi:10.1017/s1463423620000110

Abstract

Our objective was to integrate lessons learned from perinatal collaborative care programs across the United States, recognizing the diversity of practice settings and patient populations, to provide guidance on successful implementation. Collaborative care is a health services delivery system that integrates behavioral health care into primary care. While efficacious, effectiveness requires rigorous attention to implementation to ensure adherence to the core evidence base. Implementation strategies are divided into three pragmatic stages: preparation, program launch, and program growth and sustainment; however, these steps are non-linear and dynamic. The discussion that follows is not meant to be prescriptive; rather, all implementation tasks should be thoughtfully tailored to the unique needs and setting of the obstetric community and patient population. In particular, we are aware that implementation on the level described here assumes commitment of both effort and money on the part of clinicians, administrators, and the health system, and that such financial resources are not always available. We conclude with synthesis of a survey of existing collaborative care programs to identify implementation practices of existing programs.

Highlights

Collaborative care (CC) titrates the delivery of behavioral health care to the treatment intensity required for a given patient
Very often the primary care physician can implement pharmacotherapy changes, thereby efficiently reserving specialty mental health care by a psychiatrist for those patients who do not respond to earlier steps in the treatment algorithm
Significant momentum exists in implementing integrated behavioral health in the perinatal setting, but programs often fall short of true evidence-based CC and their anticipated effectiveness may diverge from what would be anticipated from a program with higher fidelity to the CC model

Summary

Introduction

Collaborative care (CC) titrates the delivery of behavioral health care to the treatment intensity required for a given patient. If the patient does not respond to the initial line of treatment, care is augmented (Katon, 2003). Very often the primary care physician can implement pharmacotherapy changes, thereby efficiently reserving specialty mental health care by a psychiatrist for those patients who do not respond to earlier steps in the treatment algorithm. Proposed benefits of CC include improved access to behavioral health, patient-centered care, receipt of behavioral and physical health care in the same familiar setting, and improved clinical outcomes. These benefits are achieved through adherence to five core principles: patient-centered team care, population-based care, measurement-based treatment to target, evidence-based care, and accountable care (Huffman et al, 2014). CC in a primary care setting is cost-effective (Katon et al, 2005; Unutzer et al, 2008; Katon et al, 2012)

Objectives

Findings

Conclusion