AHRQ Innovations Exchange | Remote Screening, Diagnosis, and Guidance Improves the Ability of Primary Care Practices to Detect and Arrange Treatment for Mental Health Problems

Remote Screening, Diagnosis, and Guidance Improves the Ability of Primary Care Practices to Detect and Arrange Treatment for Mental Health Problems

Snapshot
Summary
A mental health clinical assessment service provides remote (telephone-based) screening, diagnosis, and clinical guidance for patients seen in primary care practices who have or are suspected of having mental health or substance abuse problems. In a Veterans Affairs primary care clinic, the system significantly increased the screening and identification of patients needing mental health or substance abuse services, thus enhancing the ability to refer these patients to the care they need.

See Results sections for new outcomes regarding patient engagement rates as a result of implementation of the Behavioral Health Laboratory Model and the Use By Other Organizations sections for information about a statewide demonstration in Pennsylvania for frail elderly patients (updated November 2009).

Evidence Rating
Moderate: The evidence consists of a before-and-after comparison of key outcome measures, including number of patients screened and number of patients screening positive.

Developing Organizations
Philadelphia VA Medical Center; University of Pennsylvania


Date First Implemented
2003

Patient Population
Vulnerable Populations > Mentally ill; Military/Dependents/Veterans; Substance abusers

What They Did
Problem Addressed
Mental health disorders and substance abuse are common disorders associated with high direct and indirect costs. Routine screening for mental health disorders and substance abuse in primary care settings can improve patient outcomes, yet often does not occur. When screening does occur, it often is not formally linked to appropriate follow up assessment, treatment, and monitoring services.

A common disorder: The U.S. Preventive Services Task Force (USPSTF) estimates that 5 to 9 percent of Americans have a major depressive disorder and that depression leads to high health care utilization and $17 billion in lost work productivity annually1; estimates of total direct and indirect costs are as high as $43 billion annually.2
Mental health and substance abuse disorders are particularly prevalent among veterans: A survey based on a random sample of 1.5 million Veterans Health Administration enrollees found that 14.1 percent of the sample had been diagnosed with depression, 8.8 percent with anxiety, 7.1 percent with posttraumatic stress disorder, 8.5 percent with alcohol disorders, and 4.7 percent with schizophrenia.3

Suboptimal primary care screening: Based on a literature review of randomized trials studying depression screening in primary care practices, the USPSTF found that screening improves the accurate identification of depressed patients in primary care settings, and that treatment of depressed adults identified in primary care settings decreases clinical morbidity. However, studies have shown that usual care provided in the primary care setting fails to identify 30 to 50 percent of depressed patients.2

Inadequate followup care: Even if patients are appropriately screened in the primary care setting, they often do not receive appropriate followup care. For example, a study found that nearly one-half (48 percent) of veterans who screened positive for depression did not have an assessment in the following 6 weeks.4

Benefits of more systematic screening in primary care: Systematic screening tied to appropriate referral algorithms can lead to improvements in the detection, treatment, and outcomes of depression.1,2 Systematic screening can also improve the detection of co-occurring mental health conditions, such as substance abuse/misuse and manic symptoms.3
Benefits of motivational telephone sessions: Telephone-based referral care management can improve patient engagement by helping patient initiate psychiatric treatment and attend followup appointments.5


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AHRQ Innovations Exchange | Remote Screening, Diagnosis, and Guidance Improves the Ability of Primary Care Practices to Detect and Arrange Treatment for Mental Health Problems