How to Increase Initiation of Depression Treatment

Peter M. Yellowlees, MBBS, MD


March 18, 2019

This transcript has been edited for clarity.

This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees.

We know that most patients with psychiatric disorders are in primary care settings and that only half of them are identified. Of the 50% who are identified and referred for treatment, only half of these patients actually initiate treatment. How can we improve this situation?

A team of investigators from Columbia University in New York have performed a systematic search of publicly available databases from inception through August 2017 to identify interventions designed to increase depression treatment initiation for those patients who are actually identified.[1] Of 9516 articles identified, 14 unique studies representing 16 interventions and eight treatment initiation strategies were examined. The authors concluded that collaborative or integrated care, preference treatment matching, and case management strategies had the best evidence for improving depression treatment initiation. However, none of the strategies had high strength of evidence.

What is the take-home message from this study? First, we have to work harder and collaborate in smarter ways with our primary care colleagues. If only 50% of patients identified in primary care actually initiate mental health treatment, then overall, only 25% of possible patients seen in that setting are receiving treatment. Most of the research in collaborative care to date has examined models of care and strategies for patient identification and management.

It is clear from this study that although we have to do better at all of our collaborative activities, we also have to work harder and better to engage patients in care once they are identified and referred. This is quite a challenge, but one that, if we use the strategies identified in this study, is not impossible, as we wait for more of the research findings that are currently lacking in this area.

Thank you for listening to this Medscape Psychiatry Minute. Do continue to enjoy your practice.

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