Assessment and Management of Depression, Anxiety, and Alcohol Problems in Primary Care: The BHL Prog

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Assessment and Management of Depression, Anxiety,
and Alcohol Problems in Primary CareThe BHL
Program
David Oslin, MD

• VISN 4 MIRECC
• VA Philadelphia
• University of Pennsylvania

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

• Adaptability
• Efficiency
• Targets need
• Scalable

• Reproducible
• Ease of use
• Compassion

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InceptionKey issues

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

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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
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InceptionOther issues

• Scalability
• Ease of use
• Interface with CPRS

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Initial Beta Version

• Small scale self programmed in access
• Limited features interview only, expanded to
  registration function
• Enrollment partnership with primary care around
  screening

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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

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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

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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.

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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

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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.

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Web Resources

• http//www.va.gov/visn4mirecc/bhl/ (Behavioral
  Health Laboratory)