Evidence-Based Care For Depression In Managed Primary Care Practices

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Abstract
PROLOGUE:The gap between theory and practice in health care can be daunting. Researchers armed with massive amounts of outcomes data face the problem of translating their findings into workable interventions in the practice setting. This paper reports on an attempt to bridge the gap, taking advantage of the administrative capabilities of managed care organizations. The authors designed, implemented, and tracked a collaborative-care program of treatment for patients with symptoms of depression. The results presented here highlight the program's success in creating a “partnership between health care organizations and researchers.”Lisa Rubenstein is a practicing geriatrician and internist at the University of California, Los Angeles (UCLA), School of Medicine and Veterans Administration Medical Center (VAMC), Sepulveda, California; a senior natural scientist at RAND; and director of the VA/RAND/UCLA Center for the Study of Healthcare Provider Behavior. Maga Jackson-Triche is director of the Psychiatry Consultation and Liaison Services at the Sepulveda VAMC, and the psychiatric administrator for the PACE (Primary Care and Education) program there. Jürgen Unützer is a geriatric psychiatrist and health services researcher at the UCLA Neuropsychiatric Institute (NPI). Jeanne Miranda, a psychologist, is an associate professor of psychiatry at Georgetown University Medical Center in Washington, D.C. Katy Minnium is a research associate in the department of psychiatry at UCLA. Marjorie Pearson is a health policy analyst at RAND. Ken Wells is professor-in-residence of psychiatry and biobehavioral sciences at UCLA-NPI and a senior scientist at RAND. This paper evaluates whether externally designed, evidence-based interventions for improving care for depression can be locally implemented in managed care organizations. The interventions were carried out as part of a randomized trial involving forty-six practices within six diverse, nonacademic managed care plans. Based on evaluation of adherence to the intervention protocol, we determined that local practice leaders are able to implement predesigned interventions for improving depression care. Adherence rates for most key intervention activities were above 70 percent, and many were near 100 percent. Three intervention activities fell short of the goal of 70 percent implementation and should be targets for future improvement.