The results from the United Kingdom support CMS' decision to add a payment code for collaborative care to this year's Medicare Physician Fee Schedule.
Policy changes from CMS to promote collaborative care may offer relief for seniors in the United States who suffer from mild depression, based on the results of a new study in JAMA.
The study, known as the CASPER trial (for Collaborative Care in Screen-Positive Elders), is the largest study in the United Kingdom to examine the effects of collaborative care, which integrates mental health and primary care services under one roof. Researchers from the York Health Research Group randomized 705 adults age 65 or older into 2 groups; patients were followed for at least 12 months in 32 primary care practices.
All participants had subthreshold depression, meaning they registered some depressive symptoms on the Patient Health Questionnaire (PHQ-9), but symptoms were not severe enough to be diagnosed with depressive disorder. Patients assessed at 4 months and 12 months. Participants who received care in a collaborative setting had lower PHQ-9 scores at 4 months: 5.36 with collaborative care vs 6.67 with usual care. A score of 10 or higher meets the criteria for depressive disorder.
The gap between the groups remained at 12 months (5.93 vs 7.25), although a higher number of patients in collaborative care group were lost to follow-up (24% in collaborative care vs 10% in usual care).
“Although results persisted through 12 months, findings are limited by attrition, and further research is needed to assess long-term efficacy,” the authors concluded.
CDC estimates that 7 million US seniors, or about 18% of those age 65 or older, suffer from some level of depression. Depression leads to unhealthy behaviors, such as overeating or smoking, which can increase after retirement when people stop working and lose daily interaction with co-workers.
Collaborative care recognizes that many health problems may be rooted in depression or the loss of cognitive function, and seeks to pull down barriers—from inconvenience to stigma—that keep people from seeking mental health care. CMS added a code to this year’s Medicare Physician Fee Schedule to encourage practices to pursue this care model.
The care model has been shown to not only reduce levels of depression, but also to improve other health indicators in patients with diabetes, such as blood pressure, cholesterol, and glycated hemoglobin. The care model was pioneered in the United States by researchers at the University of Washington, who first reported on their methods in 1995. Collaborative care received a boost under the Affordable Care Act, as practices and health systems were encouraged to find ways to prevent chronic disease and its complications.
Gilbody S, Lewis H, Adamson J, et al. Effect of collaborative care vs usual care in depressive symptoms in older adults with subthreshold depression. JAMA. 2017;317(7):728-737. doi:10.1001/jama.2017.0130.