Implementing Collaborative Care for Depression Plus PTSD in Primary Care
Bradford L. Felker MD
VA Puget Sound Health Care System Seattle Division, Seattle, WA
Seattle, WA
Funding Period: April 2012 - March 2014

BACKGROUND/RATIONALE:
The VA has been supporting development of collaborative care models for improving care for Veterans with mental health (MH) needs in primary care (PC). These models enhance communication, coordination, and referrals between PC and MH. However, better strategies are needed for local PC leaders to select, adapt, and implement an optimal set of these tools.

OBJECTIVE(S):
Our objective is to use a collaborative process to implement the TIDES/PTSD model in two PC clinics, and further develop methods for implementing Veteran-centered care management that would facilitate spread of the VA's national tool kit for integration of MH services into Veteran-centered PC teams.

METHODS:
Implementation - TIDES/PTSD modifications include addition of screening, monitoring, support, education, and referral management specific for PTSD. An Expert Panel will be used to prioritize adaptations based on pilot study findings, as well as identify specific aims for tool production. Local stakeholders will participate in a tailoring process specific to each clinic. Staff at each clinic will be trained in the customized TIDES/PTSD model, and implementation support will occur in regular collaborative sessions.

Evaluation - Evaluation questions will address feasibility of implementing the TIDES/PTSD model in PC clinics, contextual factors influencing the implementation, acceptability of this model, and the ability to integrate relevant clinical outcome tools into routine care. The influence on access and processes of care will be assessed, as well as exploring influence on clinical outcomes. Data sources will include clinical data collected in the usual process of care and qualitative interviews with stakeholders.

Descriptive analysis of both quantitative and qualitative data will produce a utilization-focused case study, providing timely feedback for adjusting the implementation, and support for preparation of implementation toolkit products. A matrix strategy will be used to synthesize quantitative data on the characteristics of participating veterans, extent of use of the model, process of care, and clinical outcome measures with qualitative information about staff experiences implementing the model, and staff and patient satisfaction. Implementation tool development will use an iterative process to refine tools based on findings, plus feedback from members of the Advisory Panel

FINDINGS/RESULTS:
N/A

IMPACT:
Veterans who have depression plus PTSD are often seen in VA primary care (PC), and the combination of conditions presents extra difficulties for the individuals and for VA health care. This study seeks to address the needs of these patients by improving access to condition-specific services based in PC. This work is relevant to improving coordination between PC and specialty mental health (MH) care, and also for expanding tools to help veterans manage themselves. PC providers benefit from improved collaboration with MH, education on depression plus PTSD, and the ability to collaborate with care managers for additional patient assessment and follow up. Care managers benefit from improved tools, medical record templates, and educational resources that specifically address the needs of their depressed patients who also have PTSD. We will produce tools and reports that can be used to help expand care management for depression to include PTSD in VA PC clinics nation-wide.

PUBLICATIONS:
None at this time.

DRA: Mental, Cognitive and Behavioral Disorders
DRE: Treatment - Observational
Keywords: QUERI Implementation
MeSH Terms: none