Primary Care Physicians' Attitudes Regarding Collaborating with Home-Based Depression Care Management Providers

Abstract

Symptom Checklist-20 [HSCL-20], PHQ-9), disability (World Health Organization Disability Assessment Schedule-II, WHODAS-II), and satisfaction. Results: No participants dropped out. Depression care specialists engaged in an average of 2.4 phone calls and 6.3 faxes per client to the contact person (e.g., receptionist, nurse) at each client’s primary care clinic. In these phone calls and faxes, depression care specialists made an average of 5.4 requests per client, and physicians responded to an average of 3 requests. Each client’s physician responded to at least one collaboration request (e.g., initiating or changing dosage of antidepressant medication; reducing sleep, anxiolytic, and antipsychotic medication; changing pain medication; initiating thyroid medication). Six clients achieved meaningful reductions in PHQ-9 scores at the end of active treatment (i.e., 50% reduction, 5/6 in full remission). In paired t-tests, HSCL-20 and WHODAS-II scores improved from baseline to end of active DCM and from baseline to three months after active DCM (p 0.025). Satisfaction ratings also were favorable. Conclusions: Results of this pilot study suggest that augmenting an existing DCM protocol with a collaboration intervention is feasible to implement by depression care specialists and can improve physician collaboration and client outcomes. Larger scale research is required to determine whether augmenting home-based DCM with the collaboration intervention is more effective than DCM alone. Such research could have implications for theories and models of collaboration across service systems.