TY - JOUR
AU - L. B. Leung
AU - C. E. Brayton
AU - R. L. Shepardson
AU - C. P. Gray
AU - M. L. Lee
AU - J. S. Funderburk
AU - J. C. Fortney
A1 - 
AB - BACKGROUND: The Veterans Health Administration (VA) integrated mental and physical health services to better detect and treat depression. Primary care nurses conduct screening annually. Clinicians, including Primary Care Mental Health Integration (PCMHI) specialists, follow-up as needed for treatment. Depression detection and management processes are complex, involve multilevel stakeholders, and are subject to significant disruption from COVID-19 and from the resulting expansion of telehealth, aiming to preserve care access. This study aimed to examine whether the COVID-19 pandemic worsened depression-related care quality and/or patient outcomes (eg, suicide). METHODS: Given hypothesised care disruption (lowered care quality) during COVID-19, we will first assess the VA population's trajectory from a new positive depression (and suicide risk) screen to appropriate treatment (ie, medication, therapy) in the Fiscal Year 2019-2323. We will also examine the changing mix of virtual and in-person depression care delivered. Second, we will use interrupted time series analyses to explore the extent to which psychiatric emergency visits and hospitalisations may be mitigated by clinician detection of depression. As well as compare mental health-related mortality rates between patients detected and not detected to have depression. Subanalyses will reveal where (eg, clinics with low PCMHI access) and for whom (eg, minorities) detection does not systematically occur, and downstream negative sequelae, to guide future intervention. Finally, we will interview 40 veterans, half of whom were detected and half not detected to have depression and 40 VA primary care and PCMHI providers about changes brought on by the pandemic and the expansion of virtual care across three VA facilities. In addition to contextualising disrupted care findings, qualitative data will help identify best practices on patient-to-provider and provider-to-provider interactions in hybrid in-person/telehealth depression care models. ETHICS AND DISSEMINATION: Ethics approval was granted by the VA Greater Los Angeles Healthcare System Institutional Review Board. Alongside journal publications, dissemination activities include briefings to our policy and operational partners, and presentations to clinical, research and policy-oriented audiences.
AD - Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA lleung@mednet.ucla.edu.; Division of General Internal Medicine and Health Services Research, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.; Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York, USA.; Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.; Department of Psychology, Syracuse University, Syracuse, New York, USA.; Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA.; Department of Biostatistics, University of California Los Angeles Jonathan and Karin Fielding School of Public Health, Los Angeles, California, USA.; Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA.; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.
AN - 41401991
BT - BMJ Open
C5 - Healthcare Disparities
CP - 12
DA - Dec 15
DO - 10.1136/bmjopen-2024-094624
DP - NLM
ET - 20251215
IS - 12
JF - BMJ Open
LA - eng
N2 - BACKGROUND: The Veterans Health Administration (VA) integrated mental and physical health services to better detect and treat depression. Primary care nurses conduct screening annually. Clinicians, including Primary Care Mental Health Integration (PCMHI) specialists, follow-up as needed for treatment. Depression detection and management processes are complex, involve multilevel stakeholders, and are subject to significant disruption from COVID-19 and from the resulting expansion of telehealth, aiming to preserve care access. This study aimed to examine whether the COVID-19 pandemic worsened depression-related care quality and/or patient outcomes (eg, suicide). METHODS: Given hypothesised care disruption (lowered care quality) during COVID-19, we will first assess the VA population's trajectory from a new positive depression (and suicide risk) screen to appropriate treatment (ie, medication, therapy) in the Fiscal Year 2019-2323. We will also examine the changing mix of virtual and in-person depression care delivered. Second, we will use interrupted time series analyses to explore the extent to which psychiatric emergency visits and hospitalisations may be mitigated by clinician detection of depression. As well as compare mental health-related mortality rates between patients detected and not detected to have depression. Subanalyses will reveal where (eg, clinics with low PCMHI access) and for whom (eg, minorities) detection does not systematically occur, and downstream negative sequelae, to guide future intervention. Finally, we will interview 40 veterans, half of whom were detected and half not detected to have depression and 40 VA primary care and PCMHI providers about changes brought on by the pandemic and the expansion of virtual care across three VA facilities. In addition to contextualising disrupted care findings, qualitative data will help identify best practices on patient-to-provider and provider-to-provider interactions in hybrid in-person/telehealth depression care models. ETHICS AND DISSEMINATION: Ethics approval was granted by the VA Greater Los Angeles Healthcare System Institutional Review Board. Alongside journal publications, dissemination activities include briefings to our policy and operational partners, and presentations to clinical, research and policy-oriented audiences.
PY - 2025
SN - 2044-6055
SP - e094624
ST - Leveraging COVID-19 to modernise depression care for VA primary care populations: protocol for a sequential explanatory mixed method evaluation
T1 - Leveraging COVID-19 to modernise depression care for VA primary care populations: protocol for a sequential explanatory mixed method evaluation
T2 - BMJ Open
TI - Leveraging COVID-19 to modernise depression care for VA primary care populations: protocol for a sequential explanatory mixed method evaluation
U1 - Healthcare Disparities
U3 - 10.1136/bmjopen-2024-094624
VL - 15
VO - 2044-6055
Y1 - 2025
ER -