The case for integrating mental health services into primary care has been made. We know that primary care, the largest platform for healthcare delivery in the United States, remains the de facto mental health system. There is evidence to support combining mental health and primary care services to more comprehensively address the construct of health (mental and physical), but when making a business/policy case for such integration there is less evidence for what works and what models or elements of models should be incorporated to reach the desired health outcomes.
A recent systematic review (Butler, et al., 2008) pointed out that it is often difficult to tease apart the success of integrating mental health into primary care from the attention that a specific disease is receiving. Of the 33 studies examined, 26 focused primarily on depression. If depression were the only mental health condition we treated in primary care, we may have more answers, but it is not as patients bring complexity co-mingled with co-morbidity.
To this end, the Collaborative Care Research Network (CCRN) was created to expand the evidentiary support for mental health in primary care and to enhance the understanding of what works using a practice-based research network (PBRN) structure. To date, 40 practices have enrolled. The team developed a position paper arguing for a collaborative care PBRN and sent it to the Agency for Healthcare Research and Quality (AHRQ), after which we were advised to immediately submit a grant application as they had certain dollars that needed to be spent this fiscal year. We were also advised to keep an eye on the AHRQ website if the President's stimulus package was approved as there would be initiatives of interest.
Dr. CJ Peeks reminds us of the famous Peter Drucker quote: "In business and elsewhere, nothing ever happens except when created by a monomaniac on a mission." And monomaniacs we (CCRN) are. Even so, we are systems folks who are observing what Harry Goolishian said was the first rule of working in systems--keep the conversation going; hence this communication and blog. For more information on the CCRN, please visit www.aafp.org/nrn/ccrn
From the financial perspective, what research questions are most pressing for the collaborative care movement?
