The past generation has seen profound advances in the treatment of depression including the development of medications that are easier to use safely and effectively than classical tricyclic antidepressants, and of manual-driven psychotherapies that can be delivered reliably and effectively to a broad spectrum of patients. Research has led to an extensive body of knowledge that, in turn, has led to evidence-based recommendations. These include the USPSTF’s recommendations for screening for depression, and the AHCPR’s guidelines for the primary care treatment of major depression. These advances have raised the promise for integrating the treatment of depression with primary medical care, and for the delivery of population-based care. However, in spite of intensive efforts, this promise has not been realized. Mental disorders including depression remain stigmatized, and patients are often reluctant to engage in mental health care. Even though providers’ knowledge about depression and its treatment have increased dramatically, barriers such as the time demands for attending to depression in the face of multiple competing tasks and the differences in the cultures that underlie treatment for medical and mental health disorders remain.
This is a planning grant designed to support the development of a VISN-wide proposal for a program of dissemination and research activities whose goal is the implementation of USPSTF recommendations for screening for depression in primary care, and AHCPR guidelines for the treatment of major depression. VISN 4 and its MIRECC propose a program of intervention and dissemination research supporting implementation of USPSTF recommendations for screening and AHCPR guidelines for treatment of depression in primary care. We will be proposing two components of dissemination activities: a general component that will include academic detailing and other educational initiatives, tools for providers and patients including those developed by TIDES, empowerment of local champions, and feedback to both providers and facilities; and a specific component designed to support diffusion of a clinical innovation, a Behavioral Health Laboratory (BHL).
The BHL is designed to function in a manner similar to other more traditional clinical laboratories by offering modular patient assessments. It also offers informatic, and decision-support services that can be tailored to meet local needs. It is high in relative advantage compared to other strategies, compatible with the culture of primary care and the needs of potential adopters, reinventable in response to observed difficulties in uptake or outcomes, trialable and observable, as well as low in complexity for adopters. It is configured to include services that parallel telephone disease management, an intervention of known efficacy.
Work during the planning period has been devoted to developing the BHL, including reprogramming it to allow scalability and testing modules for the downstream components of care as well as for initial evaluations, testing its acceptability to both providers and patients, and evaluating the feasibility of providing services at multiple medical centers. Other components of the planning process have included extensive interactions with Network leadership including the Chief Medical Officer (and co-PI of this project) and those responsible for Behavioral Health, Primary Care, Care Coordination, and IRM. Finally, another component of planning is involving statistical consultation on methods for evaluating dissemination and implementation activities.
Emerging findings strongly support the acceptability and value of the BHL as an innovative component of care. Ongoing planning activities confirm the enthusiasm of the VISN leadership for USPSTF/AHCPR implementation as a vehicle for improving the care of veterans with depression.
Not yet established.
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