Abstract
We describe the design and implementation of a psychiatric collaborative care model in a University-based geriatric primary care practice. Initial results of screening for anxiety and depression are reported. Screens for anxiety and depression were administered to practice patients. A mental health team, consisting of a psychiatrist, mental health nurse practitioner and social worker, identified patients who on review of screening and chart data warranted evaluation or treatment. Referrals for mental health interventions were directed to members of the mental health team, primary care physicians at the practice, or community providers. Subjects (N=1505) comprised 38.2% of the 3940 unique patients seen at the practice during the 4-year study period. 37.1% (N=555) screened positive for depression, 26.9 % (N=405) for anxiety, and 322 (21.4%) screened positive for both. Any positive score was associated with age (p<0.033), female gender (p<0.006), and a non-significant trend toward living alone (p<0.095). 8.87% had suicidal thoughts. Screening captured the most affectively symptomatic patients, including those with suicidal ideation, for intervention. The partnering of mental health professionals and primary care physicians offers a workable model for addressing the scarcity of expertise in geriatric psychiatry.
Highlights
We describe the design and implementation of a psychiatric collaborative care model in a university-based geriatric primary care practice
The services that provide psychiatric treatment within primary care practices are known as collaborative care models (CCMs)
The total number of subjects screened during the study period was 1505, comprising 38.2% of the 3940 unique patients seen at the practice during that time
Summary
We describe the design and implementation of a psychiatric collaborative care model in a university-based geriatric primary care practice. Spurred by the high frequency of psychiatric symptoms in geriatric primary care populations, depression and anxiety [1,2,3,4] and their associated adverse consequences, mental health services have recently been brought directly to the settings in which elderly patients are found [5,6,7,8,9]. The services that provide psychiatric treatment within primary care practices are known as collaborative care models (CCMs). Large-scale trials using CCMs to manage older adults with depression or anxiety have reported encouraging results [7,8,9], sustainability in the various settings has not been firmly established [15, 16]
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