RESUMEN

Collaborative care management (CoCM) is an evidenced based approach to psychiatric treatment in primary care, yet literature examining factors associated with program adherence is lacking. This study analyzed predictors of adherence to a CoCM model of psychopharmacological treatment of depression and anxiety in primary care by conducting a retrospective cohort analysis on Veterans referred to a large VA Medical Center's CoCM program over an 18-month period. Baseline characteristics, symptomatic assessments, and covariates of interest were collected. For the primary outcome, the association between covariates and programmatic completion were analyzed. Secondary analyses assessed improvements in psychiatric symptoms. A total of 757 Veterans with depressive or anxiety disorders were included, and 256 completed the CoCM program. Baseline covariates associated with differences in completion rates included the following: age, contact with psychology prior to referral, baseline PHQ-9, baseline GAD-7, and a number of comorbid psychiatric/substance abuse covariates. After controlling for baseline differences, age remained a significant positive predictor of completion (OR 1.019, 95% CI 1.008‒1.030) and cannabis use a significant negative predictor (OR 0.507, 95% CI 0.275‒0.934). Both early improvement in PHQ-9 (OR 1.864, 95% CI 1.210‒2.872) and GAD-7 (OR 1.762, 95% CI 1.154‒2.691) scores were positive predictors. Secondary analyses showed that programmatic completion was associated with greater reductions in psychiatric symptoms. Results identified a number of modifiable parameters associated with differences in completion rates and greater symptomatic reduction for those who complete the program. Additional studies should be conducted examining interventions to optimize CoCM programs by supporting positive predictors while minimizing negative predictors.

RESUMEN

OBJECTIVE: The COVID-19 pandemic has had a profound impact on individuals with mental health (MH) disorders and on the delivery of MH services. Studies examining treatment models which did not require substantial changes to the delivery of services during pandemic restrictions, such as collaborative care management (CoCM) programs are minimal. Therefore, a longitudinal retrospective cohort analysis was conducted to examine the impacts of the COVID-19 pandemic on a psychopharmacological CoCM program. METHOD: Data was collected on all U.S. Veterans enrolled in a CoCM program at a large VA during the first 10 months of the COVID-19 pandemic and compared to a one-year prior date matched control group. Treatment in the program pre-COVID vs. treatment during the pandemic was compared in relation to baseline symptomatology, improvements in MH symptoms, and program adherence. RESULTS: 462 Veterans were referred during the control dates, compared to 351 during the pandemic. Veterans enrolled during the first four months of each study arm, done to allow for a minimum of 6 months of follow up data, had no differences in baseline symptoms of depression or anxiety. Veterans receiving care during the pandemic had higher rates of program completion than pre-pandemic controls. COVID-era Veterans had higher rates of depression response than controls, and no differences were observed in depression remission, anxiety response, or anxiety remission. CONCLUSIONS: Psychopharmacological CoCM treatment models can successfully manage depression and anxiety with no observed decrease in the effectiveness of this intervention even during periods of unprecedented disruptions to the delivery of MH services.

RESUMEN

Although there is widespread agreement about the practices associated with multitiered systems of support (MTSS) frameworks in beginning reading, we often underestimate the systems and infrastructure that schools need to implement and sustain these practices. The real work of developing these systems often happens in the detailed-oriented and often messy world of schedules, routines, meetings, and materials. The purpose of this article is to describe a K-3 reading initiative where school teams serving high percentages of students at risk for reading difficulties "delved into the details" to work to overcome the complexities inherent in implementing multitiered reading supports in high priority schools.

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