Can adding community-based partners to clinical teams boost the effectiveness of care for late-life depression? An Archstone Foundation-supported project is examining this question, testing whether enhanced team care in the primary care setting, partnered with a community agency or family members, can achieve better outcomes for older people suffering serious depression.
Depression is common among older adults and comes at a high cost to patients and their families. Major depression affects 2-5 percent of older adults living in the community, up to 10 percent of older persons in primary care clinics, and up to 30 percent of older persons with chronic medical illnesses.
The Foundation launched its Depression in Late-Life Initiative in 2014 with a multi-year grant to the University of Washington (UW), and the University of California, Davis (UC Davis) for the project, called Care Partners: Bridging Families, Clinics, and Communities to Advance Late-Life Depression Care.
Achieving the Triple Aim of Health Care
Care Partners builds on the concept of collaborative care, a patient-centered approach in primary care that treats mental health conditions—such as depression and anxiety—in an environment where older adults are comfortable and already have secure, ongoing relationships. Effective collaborative care teams use established principles of chronic illness care and draw upon shared knowledge and care plans as they work toward patient goals.
The collaborative care teams deliver proven treatments, such as antidepressant medications, and evidence-based, brief counseling strategies, like Problem-Solving Treatment, in primary care.
More than 80 studies have found collaborative, team-based care to be significantly more effective than the usual treatment for mental health conditions, such as depression and anxiety. The largest study of collaborative care to date, the IMPACT study, demonstrated that the approach more than doubles the effectiveness of depression care even in settings with existing co-located behavioral health providers. Additionally, collaborative care reduces disability, improves quality of life, and earns a return on investment of $6.50 for every $1.00 spent.
This strategy achieves the much sought after “Triple Aim” of improved patient care experiences, better clinical outcomes, and lower health care costs.
Sharing Our Learnings
One of the most promising approaches to improving the reach and effectiveness of late-life depression care is the systematic involvement of community-based organizations, family members, and primary care clinics that work with older adults.
These community-engaged partnerships have tremendous potential to improve: 1) access to care; 2) engagement in treatment; 3) the patient care experience; and 4) quality of care for depressed older adults.
As the Depression in Late-Life Initiative advances, we will be developing blog posts on a variety of topics to share what we’re learning and the best ways stakeholders can implement these powerful, evidence-based models of care.
We will share progress being made across the initiative and convey what’s happening at our project sites in California and within our learning cohorts of health systems.
Lessons for Funders
In this first post, we’d like to share some of the learnings discussed during a recent webinar hosted by Grantmakers In Aging, where I joined Dr. Ladson Hinton, MD, of UC Davis, to provide an overview on the state of depression care and the structure of the Care Partners cohort of projects.
At the conclusion of the webinar, I discussed ways that foundations and funders who are interested in improving depression care in their communities could build upon this work:
- Provide training for Board members and trustees about the importance of addressing and treating depression in older adult populations.
- Explore which clinics and health systems in your area currently offer collaborative care for depression.
- Provide local start-up cost support for primary care clinics to implement IMPACT or PEARLS collaborative care.
- Support collaborative care implementation through linking clinics to technical assistance provided at the AIMS Center at the University of Washington.
- Once collaborative care is established, support the development of partnerships with community-based organizations or family members.
- Apply the partnership model or collaborative care principles to other diseases. For example, help address improved responses and treatment plans for persons with dementia by supporting partnerships between clinics and community-based organizations.
- Help community-based organizations partner and network to approach clinics to provide services that address social determinants of health.
To learn more, we invite you to view the webinar. And please check back at Point of View for future updates as this exciting and important work continues.
