New Collaborative Care Model May Improve Mental Health Needs of Primary Care Patients

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A collaborative care program that uses a centralized resource center to facilitate intake, triage, and referral management for primary care patients with mental health needs was found to be effective and efficient in a recent study published in the Annals of Family Medicine.

“Collaborative care is a proven model for connecting both physical and mental health, which is what modern healthcare is all about,” said corresponding author Courtney Benjamin Wolk, PhD, assistant professor of psychiatry, Perelman School of Medicine, University of Pennsylvania, in a university press release. “Without a formalized process for following up with patients and providing supportive guidance, individuals in need of mental health care may fall through the cracks or receive suboptimal care.”

To that end, Wolk and colleagues launched the University of Pennsylvania Health System’s collaborative care program, Penn Integrated Care (PIC), in January 2018 to increase access to and engagement with mental health care.

Unlike typical collaborative care models that only encourage patients to be referred for further evaluation if they have mild-to-moderate mental health issues, the PIC program encouraged primary care physicians (PCPs) to refer patients with any mental health symptom or condition for further evaluation.

In the PIC program, the collaborative care team consists of the patient, PCP, a mental health provider, consulting psychiatrist, and mental health intake coordinators in the PIC Resource Center. The mental health intake coordinators assessed patients by phone, referred them to the appropriate level of care, and facilitated engagement in community-based specialty care.

Previous clinical trials have shown that traditional collaborative care programs can be effective for patients with depression or anxiety; however, the current large study is the first to demonstrate the benefits of adding a separate and designated resource center to the model.

“The benefit of this collaborative care model with a Resource Center two-fold. First, while other care models support mild-to-moderate mental health conditions, PCPs face the full spectrum of conditions and are often challenged to access appropriate care for more severe conditions—the PIC approach ensures these patients who need more specialized care are supported as well,” said Wolk in the press release.

“Second, the Resource Center alleviates the mental health professionals in the practices from becoming overwhelmed with assessment and referral activities given their limited time. This allows the mental health providers to use their time to see and treat patients, after they are evaluated through the Resource Center.”

Physicians from 8 practices participated in the PIC program and referred 6124 patients in the first 12 months. These patients reported symptoms consistent with a range of conditions from mild-to-moderate depression and anxiety to more serious mental illness such as psychosis and acute suicidal ideation.

Of the initial 6124 participants, ~97% (5931) were referred to the PIC Resource Center, and 3645 of those were screened. Among the participants who were screened, 26.4% (n=961) received an appointment with the mental health professional within the primary care practice, 70% (n=2553) were referred to community-based mental health care, 0.5% (n=17) received self-management resources, and 3.1% (n=114) declined treatment referrals.

Among participants with ≥2 more PIC encounters, 32.6% with depression and 39.5% with anxiety achieved remission of symptoms in the first year of PIC. In the years since the launch of PIC, even more patients have experienced remission, according to the press release.

Researchers also interviewed stakeholders, which included health system leaders in psychiatry and primary care, PCPs, mental health professionals (ie, psychiatrists and mental health intake coordinators), and patients, “who all viewed the program favorably,” according to the press release.

For example, PCPs who participated said they, “appreciated that they had a place to refer patients,” wrote study authors. In addition, mental health professionals, “appreciated the thorough assessments the resource center conducted—data they used in their initial mental health visits with patients—and the ability to devote time to psychotherapy,” according to study authors.

All 8 practices that implemented the PIC program continue to use it, demonstrating 100% sustainability, according to study authors.

“The results from the first year of PIC reinforce that collaborative care brings high-quality mental health care to patients in a way that is convenient, efficient, and effective. As we continue to expand our program across primary care at Penn Medicine, we hope other health systems and physician organizations look to collaborative care to meet their patients’ mental health needs,” said co-author Matthew Press, MD, physician executive of Penn Primary Care, in the same university press release.