Population level effectiveness of implementing collaborative care management for depression

Abstract

Objective: Care management is feasible to deploy in routine care, and the depression outcomes of patients reached by this evidence-based practice are similar to those observed in randomized controlled trials. However, no studies have estimated the population level effectiveness of care management when deployed in routine care. Population level effectiveness depends on both reach into the target population and the clinical effectiveness for those reached.

Method: This multisite hybrid Type 3 effectiveness-implementation study employed a pre-post, quasi-experimental design. The study was conducted at 22 Veterans Affairs community-based outpatient clinics. Evidence-based quality improvement was used as the facilitation strategy to promote adoption. Medication possession ratios (MPRs) were calculated for 1558 patients with an active antidepressant prescription. Differences in treatment response rates at implementation and control sites were estimated from observed differences in MPR.

Results: Reach into the target population at implementation sites was 10.3%. Patients at implementation sites had a significantly higher probability of having MPR≥0.9 than patients at control sites [odds ratio=1.38, confidence interval95=(1.07, 1.78), P=.01]. This increase in MPR was estimated to yield a 1% point increase in response rates.

Conclusions: While depression care management improves outcomes for patients receiving services, low levels of reach can reduce overall population level effectiveness.

Keywords: Collaborative care management; Depression; Implementation.

Published by Elsevier Inc.