Addressing Common Challenges in the Implementation of Collaborative Care for Mental Health: The Penn Integrated Care Program.

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TitleAddressing Common Challenges in the Implementation of Collaborative Care for Mental Health: The Penn Integrated Care Program.
Publication TypeJournal Article
Year of Publication2021
AuthorsWolk, CBenjamin, Last, BS, Livesey, C, Oquendo, MA, Press, MJ, Mandell, DS, Ingram, E, Futterer, AC, Kinkler, GP, Oslin, DW
JournalAnn Fam Med
Date Published2021 Mar-Apr
KeywordsAnxiety, Cooperative Behavior, Delivery of Health Care, Integrated, Humans, Mental Disorders, Mental Health, Patient Care Team, Primary Health Care, Program Development, Program Evaluation

PURPOSE: We developed and implemented a new model of collaborative care that includes a triage and referral management system. We present initial implementation metrics using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework.

METHODS: Primary care clinicians in 8 practices referred patients with any unmet mental health needs to the Penn Integrated Care program. Assessments were conducted using validated measures. Patients were primarily triaged to collaborative care (26%) or specialty mental health care with active referral management (70%). We conducted 50 qualitative interviews to understand the implementation process and inform program refinement. Our primary outcomes were reach and implementation metrics, including referral and encounter rates derived from the electronic health record.

RESULTS: In 12 months, 6,124 unique patients were referred. Assessed patients reported symptoms consistent with a range of conditions from mild to moderate depression and anxiety to serious mental illnesses including psychosis and acute suicidal ideation. Among patients enrolled in collaborative care, treatment entailed a mean of 7.2 (SD 5.1) encounters over 78.1 (SD 51.3) days. Remission of symptoms was achieved by 32.6% of patients with depression and 39.5% of patients with anxiety. Stakeholders viewed the program favorably and had concrete suggestions to ensure sustainability.

CONCLUSIONS: The Penn Integrated Care program demonstrated broad reach. Implementation was consistent with collaborative care as delivered in seminal studies of the model. Our results provide insight into a model for launching and implementing collaborative care to meet the needs of a diverse group of patients with the full range of mental health conditions seen in primary care.

Alternate JournalAnn Fam Med
PubMed ID33685876
PubMed Central IDPMC7939709
Grant ListP50 MH113840 / MH / NIMH NIH HHS / United States