A recent study by Kaiser Permanente Northern California (KPNC) published in the Journal of Clinical Psychiatry, comparing traditional psychiatric treatment with a team-based collaborative care approach, found significant improvements in depression and anxiety symptoms in both models. The collaborative care model, however, demonstrated even stronger results, particularly during the COVID-19 pandemic when telehealth was heavily utilized.
Collaborative Care vs. Specialty Psychiatric Care
The study involved 1,607 patients with mild-to-moderate depression in collaborative care and 8,773 in specialty psychiatry, along with 570 anxiety patients in collaborative care and 2,365 in specialty psychiatry. Symptoms were tracked over six months, from 2020 to 2021. Collaborative care patients with depression saw an average 9-point improvement on the 27-point Patient Health Questionnaire-9, while those with anxiety experienced a 5.4-point reduction on the 27-point Generalized Anxiety Disorder-7 Scale. In contrast, patients in specialty psychiatry saw a 5-point and 2.8-point reduction in depression and anxiety symptoms, respectively.
Key Components of Collaborative Care
The collaborative care model at KPNC focuses on frequent symptom monitoring and personalized treatment, delivered by therapists with pharmacist support. This approach includes measurement-based care, where regular symptom assessments guide clinical decisions. According to Kathryn Erickson-Ridout, MD, PhD, a psychiatrist with The Permanente Medical Group, this structured engagement leads to better patient outcomes.
Remission Rates and Clinical Significance
Notably, a high proportion of depression patients achieved full remission in both programs. Specifically, 43% of collaborative care patients and 27% of specialty care patients reached full remission, significantly higher than the national average of around 10%. Erickson-Ridout emphasized that this level of improvement can lead to improved functioning and reduced risk of relapse.
Addressing Mental Health Clinician Shortage
Another advantage of collaborative care is its potential to alleviate the national shortage of mental health clinicians. By involving therapists and pharmacists in a team-based approach, psychiatrists can extend their reach and provide more comprehensive care. Maria T. Koshy, MD, a psychiatrist with The Permanente Medical Group, highlighted that this initiative supports multi-disciplinary programs aimed at delivering rapid and significant symptom relief.
Telehealth and Accessibility
Lisa Fazzolari, DO, a TPMG psychiatrist, noted that the telehealth platform has allowed for easy and convenient access to treatment for a large patient population. Since its inception in April 2020, the virtual collaborative care program has treated over 37,000 patients with depressive and anxiety disorders. KPNC is also exploring collaborative care for depression and anxiety during pregnancy through a new pilot program.
