Oral Papers: Collaborative Care & Community C-L I
Background / Significance: Collaborative care is now well established as an evidence-based approach to improving depression and other common mental disorders in primary care. We present findings from the Care Partners Initiative which seeks to extend the reach and effectiveness of primary care-based collaborative care programs through partnerships with community-based organizations (CBOs). This approach reaches outside the walls of primary care to engage and treat patients in the community.
Methods: As part of the Care Partners Initiative, six California-based clinic + CBO partnerships received funding to implement ‘partnered’ collaborative care for older adults with depression. Using a mixed-methods research design, we examined the successes and challenges of the Care Partners Initiative.
Results: Key findings include the following: (1) CBOs can make important contributions that expand and enhance the collaborative care services that primary care clinics can provide; (2) partnerships among clinics and CBOs are complex and need substantial initial investment and ongoing support; (3) partnered collaborative care has outcomes similar to traditional implementations of collaborative care and may improve on access and patient satisfaction outcomes. During the first two years of the pilot project, 62% of depressed older adults enrolled in partnered collaborative care showed improvement in depressive symptoms as defined by a 50% improvement in PHQ-9 scores or last PHQ-9 below 10 (n=247). Program implementation costs ranged from $39,280 to $60,575 while cost of care per patient ranged from $154 to $544 per month. Qualitative analyses suggest that CBOs enhance late-life depression care by addressing the social determinants of health, develop creative solutions for identifying and recruiting patients, and help engage racially and ethnically diverse populations.
Discussion: Partnering with CBOs provides opportunities for clinics to extend collaborative care for medically complex patients into patients’ homes and communities, but effective partnerships require substantial initial development and up-front costs and sustained commitment to effective partnership.
Conclusion: Partnerships between primary care clinics providing collaborative care and CBOs can extend the reach of collaborative care programs into the community.