This R-34 application Rural Mental Health (MH) Centers: Improving Evidence-Based Practice (EBP) for Depression responds to RFA-MH-05-004 """"""""State Implementation of Evidence-Based Practices II - Bridging Science and Service"""""""" to pilot a rural community mental health center's (CMHC) implementation of a well tested program to leverage rural primary care provider (PCP) efforts to deliver evidence-based care to patients with major depression.
The specific aims of the study are: (1) to establish CMHC infrastructure to provide an integrated depression care program; (2) to evaluate the success of program implementation from the perspective of the patient, the provider(s), and the payer; (3) to estimate adoption (program infrastructure establishment) and maintenance (program delivery) costs; and (4) to describe program adaptations that are needed to increase program success in rural areas. This application proposes to conduct an RCT in 110 rural patients beginning a new treatment episode who have been referred to by their PCP. After baseline data have been collected, patients will be randomized to an integrated care program (psychiatrist-supervised care management provided through the state-contracted CMHC plus PCP treatment) or supplemented usual care (depression education videotape plus PCP treatment). Patients will be followed at 6 and 12 months to determine intervention impact on evidence-based depression care, hospital utilization, and other important outcomes. This application will advance the application of scientific knowledge by demonstrating the feasibility of CMHC-PCP collaboration to increase evidence-based depression care at a time when both CMHC administrators and PCPs in rural Colorado are publicly recognizing the need to constructively collaborate, rather than work in isolation as they have historically done. Results from a successful pilot project will be used to educate key state/national stakeholders on the potential for this model to contribute to rural patients, providers, and health plans, so that a widespread demonstration project can be conducted.
