TY - JOUR
AU - K. K. Ridout
AU - M. Alavi
AU - C. Lee
AU - L. Fazzolari
AU - S. J. Ridout
AU - M. T. Koshy
AU - B. Harris
AU - S. Awsare
AU - C. M. Weisner
AU - E. Iturralde
A1 - 
AB - Objective: While collaborative care is known to improve depressive and anxiety symptoms in primary care, comparative effectiveness studies of virtual collaborative care versus virtual specialty psychiatry treatment in real world settings are lacking. This study examined patient depressive and anxiety symptoms over 6 months in collaborative care versus specialty psychiatry. Methods: This was an observational study with target trial emulation in a large, community-based, integrated health care system. Participants were ≥18 years old with mild-moderate depressive or anxiety symptoms measured by the Patient Health Questionnaire-9 or Generalized Anxiety Disorder-7 Scale. Exclusion criteria included acute suicide risk. Patients were assigned to collaborative care or specialty psychiatry, and symptoms were measured 6 months after treatment initiation using linear mixed-effects regression with inverse probability of treatment weighting. Results: There were N = 10,380 patients (n = 1,607 in collaborative care; n = 8,773 in specialty psychiatry) with depressive disorders and N = 2,935 (n = 570 in collaborative care; n = 2,365 in specialty psychiatry) with anxiety disorders. Model effects at 6 months showed significant symptom improvement for patients in collaborative care (adjusted mean difference [AMD] = -9.0, 95% CI, -9.7, -8.4 for depression; -5.4, 95% CI, -6.2, -4.7 for anxiety) and in specialty psychiatry (AMD = -5.0, 95% CI, -5.6, -4.5 for depression; -2.8, 95% CI, -3.6, -2.1 for anxiety), with patients in collaborative care showing significantly greater improvement compared to those in specialty psychiatry (AMD = -4.0, 95% CI, -4.7, -3.3, P < .0001 for depression; AMD = -2.6, 95% CI, -3.4, -1.8, P < .0001 for anxiety). Conclusions: Virtual collaborative care was at least as effective as specialty psychiatry for depression and anxiety. Collaborative care implementation can support national guidelines regarding depression and anxiety screening and treatment.
AD - The Permanente Medical Group, Kaiser Permanente Northern California, Oakland, California.; Division of Research, Kaiser Permanente Northern California, Oakland, California.; Corresponding Author: Kathryn K. Ridout, MD, PhD, Kaiser Permanente Northern California, 401 Bicentennial Way, Santa Rosa, CA 95403 (Kathryn.Erickson-Ridout@KP.org).; Kaiser Foundation Hospitals, Kaiser Permanente Northern California, Oakland, California.
AN - 39240697
BT - J Clin Psychiatry
C5 - HIT & Telehealth
CP - 3
DA - Sep 4
DO - 10.4088/JCP.24m15332
DP - NLM
ET - 20240904
IS - 3
JF - J Clin Psychiatry
LA - eng
N2 - Objective: While collaborative care is known to improve depressive and anxiety symptoms in primary care, comparative effectiveness studies of virtual collaborative care versus virtual specialty psychiatry treatment in real world settings are lacking. This study examined patient depressive and anxiety symptoms over 6 months in collaborative care versus specialty psychiatry. Methods: This was an observational study with target trial emulation in a large, community-based, integrated health care system. Participants were ≥18 years old with mild-moderate depressive or anxiety symptoms measured by the Patient Health Questionnaire-9 or Generalized Anxiety Disorder-7 Scale. Exclusion criteria included acute suicide risk. Patients were assigned to collaborative care or specialty psychiatry, and symptoms were measured 6 months after treatment initiation using linear mixed-effects regression with inverse probability of treatment weighting. Results: There were N = 10,380 patients (n = 1,607 in collaborative care; n = 8,773 in specialty psychiatry) with depressive disorders and N = 2,935 (n = 570 in collaborative care; n = 2,365 in specialty psychiatry) with anxiety disorders. Model effects at 6 months showed significant symptom improvement for patients in collaborative care (adjusted mean difference [AMD] = -9.0, 95% CI, -9.7, -8.4 for depression; -5.4, 95% CI, -6.2, -4.7 for anxiety) and in specialty psychiatry (AMD = -5.0, 95% CI, -5.6, -4.5 for depression; -2.8, 95% CI, -3.6, -2.1 for anxiety), with patients in collaborative care showing significantly greater improvement compared to those in specialty psychiatry (AMD = -4.0, 95% CI, -4.7, -3.3, P < .0001 for depression; AMD = -2.6, 95% CI, -3.4, -1.8, P < .0001 for anxiety). Conclusions: Virtual collaborative care was at least as effective as specialty psychiatry for depression and anxiety. Collaborative care implementation can support national guidelines regarding depression and anxiety screening and treatment.
PY - 2024
SN - 0160-6689
ST - Virtual Collaborative Care Versus Specialty Psychiatry Treatment for Depression or Anxiety
T1 - Virtual Collaborative Care Versus Specialty Psychiatry Treatment for Depression or Anxiety
T2 - J Clin Psychiatry
TI - Virtual Collaborative Care Versus Specialty Psychiatry Treatment for Depression or Anxiety
U1 - HIT & Telehealth
U3 - 10.4088/JCP.24m15332
VL - 85
VO - 0160-6689
Y1 - 2024
ER -