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Outcomes of a quality improvement project integrating mental health into primary care
  1. Bradley V Watts1,
  2. Brian Shiner2,
  3. Andrew Pomerantz3,
  4. Patricia Stender3,
  5. William B Weeks1
  1. 1Outcomes REAP, White River Junction VAMC, White River Junction, Vermont, USA
  2. 2Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire, USA
  3. 3Department of Psychiatry, White River Junction VA Medical Center, White River Junction, Vermont, USA
  1. Correspondence to:
 Dr Bradley V Watts
 VAMC (11Q), WRJ, VT 05009, USA; bradley.v.watts{at}


Objective: Depression is commonly seen, but infrequently adequately treated, in primary care clinics. Improving access to depression care in primary care clinics has improved outcomes in clinical trials; however, these interventions are largely unstudied in clinical settings. This study examined the effectiveness of a quality improvement project improving access to mental healthcare in a large primary care clinic.

Methods: A before–after study evaluating the efficacy of the integration of a primary mental healthcare (PMHC) clinic into a large primary care clinic at the White River Junction, Vermont Veterans Affairs Medical Center (VAMC). In the before period (2003), a traditional referral and schedule model was used to access mental healthcare services. Patients who had screened positive for depression using a depression screen for 6 months after entry into either model were retrospectively followed. VA clinics without a PMHC were used as a control. The proportion of patients who received any depression treatment and guideline-adhering depression treatment in each model was compared, as well as the volume of patients seen in mental health clinics and the wait time to be seen by mental health personnel.

Results: 383 and 287 patients screened positive for depression at VAMC and the community-based outreach clinic, respectively. Demographics of the before and after cohorts did not differ. The PMHC model was associated with a greater proportion of patients who had screened positive for depression obtaining some depression treatment (52.3% vs 37.8%; p<0.001), an increase in guideline-adherent depression treatment for depression (11% vs 1%; p<0.001).

Conclusions: Implementation of the PMHC model was associated with more rapid and improved treatment for depression in the population of patients who screened positive for depression. More widespread implementation of this model should be investigated.

  • PMHC, primary mental healthcare (clinic)
  • VAMC, Veterans Affairs Medical Center

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  • Funding: This work was supported in part by VA Health Services Research and Development Grant REAP 03-098.

  • Competing interests: None declared.

  • The views expressed in this article do not necessarily represent the views of the Department of Veterans Affairs or of the United States government. BW had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.