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VISN 4 MIRECC VA Philadelphia University of Pennsylvania

Assessment and Management of Depression, Anxiety, and Alcohol Problems in Primary Care: The BHL Program. David Oslin, MD. VISN 4 MIRECC VA Philadelphia University of Pennsylvania. Development of a Sustainable Clinical Innovation. Conceptualization and Investment. Implementation.

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VISN 4 MIRECC VA Philadelphia University of Pennsylvania

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  1. Assessment and Management of Depression, Anxiety, and Alcohol Problems in Primary Care:The BHL Program David Oslin, MD VISN 4 MIRECC VA Philadelphia University of Pennsylvania

  2. Development of a Sustainable Clinical Innovation Conceptualization and Investment Implementation Re-engineering Stakeholder input Marketing/Dissemination Sustainable Service

  3. Adaptability Efficiency Targets need Scalable Reproducible Ease of use Compassion Development Principals

  4. InceptionKey issues • Scope: Cognition, depression, anxiety, alcohol • Functions: Triage, decision support, monitoring • Flexibility: ability to profile patients • Enrollment: how to get patients to come

  5. BHL Clinical Process Patient Identification By screening or clinical assessment Patient Education and Promote self-care BHL Initial Assessment Provider Recommendations Referral to MH/SA care Disease Management in Primary Care No treatment / “False positive” screen Watchful Waiting/ Brief Interventions

  6. InceptionOther issues • Scalability • Ease of use • Interface with CPRS

  7. Initial Beta Version • Small scale: self programmed in access • Limited features: interview only, expanded to registration function • Enrollment: partnership with primary care around screening

  8. Contracting out • No to CPRS integration – a big decision • Interviewing software firms • Developing design features for the programming: scalability, integration of change, building on • Development of a mechanism to track, test, and deploy changes

  9. Quality Control • Data: range checks, limited input, limited capacity to change values (administrator) • Input: staff training • Acceptability: provider use, patient satisfaction, completion rates • Algorithms: comparison to clinical interviews, randomized trials of key components, long term outcomes • Program: EPRP measures, acceptability, management

  10. Core Assessment Module • During the last 12 months • 3779 patients were referred (from 2 VAMCs) • 81.7% had a complete assessment • PTSD (84%) • Alcohol or drug problems (73%). • no differences in completion rates between the Medical Center and CBOCs.

  11. Treatment Components • Core Assessment – comprehensive • Depression Module • 2, 6, 9 Weeks • Adherence, Depressive symptoms, Side effects • Watchful Waiting • 8 weekly calll • Alcohol Brief intervention and followup • Referral management

  12. Addressing Quality Indicators • Access – The triage and tracking mechanisms allow for seemless referral and the ability to reduce waiting times, prioritize care, and provide administrative support for monitoring. • Screening – The BHL has been associated with greater screening rates as well as changes in the proportion that screens positive. • Follow-up of positive screens – The BHL is directly addressing assessment of those with positive screens. • Monitoring of new initiated treatment – The depression monitoring provides a straightforward mechanism for ongoing monitoring.

  13. Web Resources • http://www.va.gov/visn4mirecc/bhl/(Behavioral Health Laboratory)

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