Collaborative and Integrated Care
PO-032
Background:
Collaborative Care (CC) is an evidence-based method of treating behavioral health conditions in primary care. Understanding how CC programs can meaningfully engage patients is central to promoting positive outcomes. Research on patient engagement in CC is sparse and extant definitions of meaningful engagement are varied. Past research on demographic and clinical factors predicting meaningful engagement has yielded mixed results.
In this study, we aimed to provide an operationalized definition of and identify factors associated with meaningful engagement in CC.
Methods:
To provide an operationalized definition of meaningful engagement, we incorporated extant examples with qualitative and quantitative information from a CC program implemented in an academic medical system (UW Health, Madison, WI).
We conducted analyses on program evaluation data from episodes of care (N=6481). We used chi-square tests to examine demographic and clinical variables that could predict meaningful engagement in CC.
Results
We defined meaningful engagement as having had three or more contacts with the CC team; documentation of PHQ-9 and GAD-7 was used as an indicator of contact. Of the 6,481 episodes, 57% were meaningfully engaged based on this definition.
In our sample, men, patients who identified as White, patients who identified as non-Hispanic or Latino, and patients who received a warm handoff at referral were more likely to be engaged. Greater symptom severity on the PHQ-9 and GAD-7 was associated with higher likelihood of meaningful engagement. Patients who completed an intake but were never reviewed by the psychiatrist were less likely to be meaningfully engaged.
Conclusion
Our results highlight several factors associated with meaningful engagement that could be incorporated into CC recruitment and treatment workflows. Presence of a case review by the CC psychiatrist was significantly associated with meaningful engagement and had the largest effect size. Case review provides an opportunity to re-evaluate the patient’s treatment plan, explore barriers to care, and facilitate optimal engagement. More severe initial symptoms and having a warm handoff were associated with increased engagement in CC. We believe the proactive nature of and frequent outreach in CC allowed for greater engagement of severely ill patients. We view the warm handoff as a technique that facilitates a transfer of the patient’s trust in the PCP to the CC team, thereby increasing the likelihood a patient will be receptive to CC services.
References:
Belyeu B, Chwastiak L, Russo J, Kiefer M, Mertens K, Chew L, Jackson SL. Barriers to Engagement in Collaborative Care Treatment of Uncontrolled Diabetes in a Safety-Net Clinic. Diabetes Educ. 2017 Dec;43(6):621-630.
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Setodji CM, Watkins KE, Hunter SB, McCullough C, Stein BD, Osilla KC, Ober AJ. Initiation and engagement as mechanisms for change caused by collaborative care in opioid and alcohol use disorders. Drug Alcohol Depend. 2018 Nov 1;192:67-73
Heather Huang, MD
– Clinical Associate Professor, University of Wisconsin, Madison, WI, United StatesKathleen McCraw, PhD
– Clinical Psychologist, UW Health, Madison, WI, United StatesMollie Moore, PhD
– Clinical Psychologist, UW Health, Madison, WI, United States