I03 – What If More BHCs Is Not the Answer? PCBH, Depression Remission, and How Examining Your Blind Spots Can Help You “FLEX” Into the Future

Summary

Depression is a significant public health concern in the United States. Symptoms of depression have increased over the course of the COVID-19 pandemic. Depressive symptoms, measured by the Patient Health Questionnaire – 9 (PHQ-9), were observed to increase in a national sample of U.S. adults between pre-COVID-19 and during the COVID-19 pandemic; overall, the rate increased from 8.5% to 27.8% according to Ettman et al. (2020), who noted specific risk factors for depression as earning a lower income, having less than $5,000 in savings, and greater exposure to stressors of the pandemic. Center for Disease Control and Prevention estimates suggest rates of depressive symptoms as high as 41.5% across the US population in February 2021 (Vahratian et al., 2021). To address these concerns a variety of integration models have been developed and implemented to place behavioral health professional in primary care clinics. The Primary Care Behavioral Health (PCBH) model focuses on population health metrics and places Behavioral Health Consultants into clinics to address a wide range of primary care concerns. Often PCBH models will prioritize metrics focused on the population reach and its ability to see many times more patients than other integration models due to brief intervention, team based care, and parallels to primary care workflows. PCBH metrics highlight the strengths of this model and reinforce the fidelity to the PCBH model. Despite significant data around PCBH, few programs gather data outside of their own integration model’s designed metrics. This focus on measuring only within a specific model creates “bind spots” in quality and patient care evaluation. To alleviate this potential barrier, this project reviewed outcome data regarding PHQ-9 scores within a target population of adults with diagnosed depressive conditions. In measuring changes in PHQ-9 scores over 12 months, data was collected to determine how depression symptoms changed over time. Additionally multiple patient factors were reviewed to determine possible correlations between changes in Depression symptoms over this time frame. This review provided insightful data about the specific program, interventions, and the patient population, but more importantly identified a sub-population within the adults with depression which did not respond to PCBH and primary care interventions. Statistical review of this data creates opportunities to think beyond the PCBH model and allows for a hypothesis of additional strategies which may provide further benefits to future integration models. Ultimately a data driven strategy utilizing several integrated approaches and variety of behavioral health team members could provide added benefits to any one model. This enhancement would lead to improvement across patient outcomes, satisfaction and also lead to better efficiency in primary care reducing stress on providers and lowers the cost of care to the healthcare system.