- Olivia Bogucki, PhD, Postdoctoral Fellow, Mayo Clinic, Rochester, MN
- Mark Williams, MD, Associate Professor of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
- William Leasure, MD, Psychiatrist, Mayo Clinic, Rochester, MN
- Scott Breitinger, MD, Psychiatrist, Mayo Clinic, Rochester, MN
- Angela Mattson, DNP RN NE-BC, Nursing Administrator, Mayo Clinic, Rochester, MN
- Craig Sawchuk, PhD, ABPP, IBH Division Co-Chair, Clinical Psychologist, Mayo Clinic, Rochester, MN
Background: Depression is the most common mental health condition with prevalence rates ranging from 8-14% in primary care (PC) settings . While evidence-based treatments are available, access to these services can be challenging. Moreover, many patients do not attain remission and are vulnerable to a relapsing-remitting course . Consequently, there has been a call for increased services in PC . While collaborative care programs have been shown to help patients achieve and maintain remission over time, they have not yet been employed on a national level . This presentation details an integrated care coordination (ICC) program for depression delivered in PC, focusing on lessons learned over time to improve future implementation and expansion efforts. Methods: Multiple iterations of the ICC program have been employed. Across iterations, nurses serve as the primary liaison between patients and providers to enhance engagement and enhance engagement in evidence-based care. Psychiatrists provide weekly supervision and consultation to a panel of depressed patients. Qualitative information about the program was obtained from multiple stakeholders. Results: In all iterations, there has been a focus on training and supervision to ensure fidelity. The first iteration was a quality improvement process and the second iteration was the Depression Improvement Across Minnesota, Offering a New Direction (DIAMOND) program. Both exemplified the importance of obtaining reimbursement for sustainability. The third, fourth, and fifth iterations included depressed patients diagnosed with anxiety disorders, bipolar disorder, or medical conditions respectively. In these iterations, it was challenging to standardize services, define outcomes, and determine readiness for discharge. Consequently, the DIAMOND program foundations have been re-implemented. Conclusion: The ICC program has been integral to serving the needs of the PC population. Lessons learned include identifying clear measures and workflows, establishing evidence, maintaining fidelity, reporting outcomes, and collaborating with stakeholders for sustainability, which have been echoed in the literature . These lessons have informed efforts to improve and expand the ICC program across a wider region, especially clinics in rural areas.
- Discuss the evidence supporting integrated care coordination programs as an effective and efficacious treatment for depression.
- Identify challenges associated with implementing integrated care coordination programs in primary care settings.
- Describe the ways in which integrated care coordination programs can be improved and implementation can be increased.