Zuschlag Zachary D, Lord Benjamin, Smith Teagen, Lengerich Alexander, Tindall Brianna, Leonard Kaitlin, Guereca Yvette, Panaite Vanessa, Kumar Ambuj, Norred Michael A, Milsom Vanessa A
James A. Haley Veterans Hospital, Tampa, FL, USA.
University of South Florida, Tampa, FL, USA.
J Behav Health Serv Res. 2025 Jan;52(1):19-31. doi: 10.1007/s11414-024-09904-4. Epub 2024 Aug 23.
Collaborative care management (CoCM) is an evidenced based approach to psychiatric treatment in primary care, yet literature examining factors associated with program adherence is lacking. This study analyzed predictors of adherence to a CoCM model of psychopharmacological treatment of depression and anxiety in primary care by conducting a retrospective cohort analysis on Veterans referred to a large VA Medical Center's CoCM program over an 18-month period. Baseline characteristics, symptomatic assessments, and covariates of interest were collected. For the primary outcome, the association between covariates and programmatic completion were analyzed. Secondary analyses assessed improvements in psychiatric symptoms. A total of 757 Veterans with depressive or anxiety disorders were included, and 256 completed the CoCM program. Baseline covariates associated with differences in completion rates included the following: age, contact with psychology prior to referral, baseline PHQ-9, baseline GAD-7, and a number of comorbid psychiatric/substance abuse covariates. After controlling for baseline differences, age remained a significant positive predictor of completion (OR 1.019, 95% CI 1.008‒1.030) and cannabis use a significant negative predictor (OR 0.507, 95% CI 0.275‒0.934). Both early improvement in PHQ-9 (OR 1.864, 95% CI 1.210‒2.872) and GAD-7 (OR 1.762, 95% CI 1.154‒2.691) scores were positive predictors. Secondary analyses showed that programmatic completion was associated with greater reductions in psychiatric symptoms. Results identified a number of modifiable parameters associated with differences in completion rates and greater symptomatic reduction for those who complete the program. Additional studies should be conducted examining interventions to optimize CoCM programs by supporting positive predictors while minimizing negative predictors.
协作式护理管理（CoCM）是一种基于证据的初级保健中精神疾病治疗方法，但缺乏考察与项目依从性相关因素的文献。本研究通过对在18个月期间转诊至一家大型退伍军人事务部（VA）医疗中心CoCM项目的退伍军人进行回顾性队列分析，分析了初级保健中抑郁症和焦虑症的精神药物治疗CoCM模式依从性的预测因素。收集了基线特征、症状评估和感兴趣的协变量。对于主要结局，分析了协变量与项目完成之间的关联。二次分析评估了精神症状的改善情况。共纳入757名患有抑郁或焦虑障碍的退伍军人，其中256人完成了CoCM项目。与完成率差异相关的基线协变量包括：年龄、转诊前与心理医生的接触、基线PHQ-9、基线GAD-7，以及一些共病精神疾病/物质滥用协变量。在控制基线差异后，年龄仍然是完成项目的显著正向预测因素（比值比[OR]1.019，95%置信区间[CI]1.008‒1.030），而大麻使用是显著负向预测因素（OR 0.507，95%CI 0.275‒0.934）。PHQ-9（OR 1.864，95%CI 1.210‒2.872）和GAD-7（OR 1.762，95%CI 1.154‒2.691）评分的早期改善都是正向预测因素。二次分析表明，项目完成与精神症状的更大程度减轻相关。结果确定了一些与完成率差异相关的可改变参数，以及对于完成项目的人更大程度的症状减轻。应该进行更多研究，考察通过支持正向预测因素同时最小化负向预测因素来优化CoCM项目的干预措施。
