Psych · Public and community psychiatry — collaborative care and primary care
Collaborative care and primary care psychiatry
Also known as Collaborative Care Model · CoCM · IMPACT model · TEAMcare · Primary care mental health · Integrated behavioural health · Measurement-based care primary care · Psychiatric consultation primary care · Stepped care depression · AIMS Center collaborative care
Exam-exhaustive fellowship reference on collaborative care and primary care psychiatry: Wagner Chronic Care Model roots, five CoCM principles, IMPACT/TEAMcare/CADET/Cochrane evidence, PHQ-9/GAD-7 measurement-based care, caseload review, tele-collaborative care, multimorbidity, fidelity and regional guidelines. FRANZCP-primary, globally tagged.
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Red flags
- Active suicidal intent or plan, psychosis, mania, severe agitation, or medical instability — escalate to crisis/specialty pathways; collaborative care is not a crisis substitute
- PHQ-9 item 9 positive without documented risk assessment and safety plan
- Screening programmes without treatment capacity or registry follow-up (unethical false reassurance)
- Calling co-location collaborative care without population registry, measurement-based treatment to target, and psychiatric caseload review
- Therapeutic inertia: serial high PHQ-9 without treatment change or step-up
- Withholding antidepressant or psychological care while waiting for perfect specialty access when CoCM capacity exists
Meet the patient
A 68-year-old man with type 2 diabetes sits in his GP's room tired, sleeping badly, and scoring 16 on the PHQ-9 the practice nurse ran that morning. His GP started citalopram nine days ago at half the usual dose and told him to come back in three months. No review is booked. His HbA1c has drifted up. Nobody has asked about his mood since.[1][3]
Two exam questions are now live: why is he not improving? and what system would actually move his numbers? The answer to both is the same — this is not a drug failure, it is an organisational failure the Collaborative Care Model was designed to fix.[13][14]
References16ShowHide
- [1]Unützer J, Katon W, Callahan CM, et al. Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial JAMA, 2002.PMID 12472325
- [2]Archer J, Bower P, Gilbody S, et al. Collaborative care for depression and anxiety problems Cochrane Database Syst Rev, 2012.PMID 23076925
- [3]Katon WJ, Lin EH, Von Korff M, et al. Collaborative care for patients with depression and chronic illnesses N Engl J Med, 2010.PMID 21190455
- [4]Gilbody S, Bower P, Fletcher J, et al. Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes Arch Intern Med, 2006.PMID 17130383
- [5]Richards DA, Hill JJ, Gask L, et al. Clinical effectiveness of collaborative care for depression in UK primary care (CADET): cluster randomised controlled trial BMJ, 2013.PMID 23959152
- [6]Bower P, Gilbody S, Richards D, et al. Collaborative care for depression in primary care. Making sense of a complex intervention: systematic review and meta-regression Br J Psychiatry, 2006.PMID 17139031
- [7]Wagner EH, Austin BT, Davis C, et al. Improving chronic illness care: translating evidence into action Health Aff (Millwood), 2001.PMID 11816692
- [8]Kroenke K, Spitzer RL, Williams JB The PHQ-9: validity of a brief depression severity measure J Gen Intern Med, 2001.PMID 11556941
- [9]Spitzer RL, Kroenke K, Williams JB, Löwe B A brief measure for assessing generalized anxiety disorder: the GAD-7 Arch Intern Med, 2006.PMID 16717171
- [10]Fortney JC, Pyne JM, Kimbrell TA, et al. Telemedicine-based collaborative care for posttraumatic stress disorder: a randomized clinical trial JAMA Psychiatry, 2015.PMID 25409287
- [11]Thota AB, Sipe TA, Byard GJ, et al. Collaborative care to improve the management of depressive disorders: a community guide systematic review and meta-analysis Am J Prev Med, 2012.PMID 22516495
- [12]Coventry P, Lovell K, Dickens C, et al. Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease BMJ, 2015.PMID 25687344
- [13]Katon W, Von Korff M, Lin E, et al. Collaborative management to achieve treatment guidelines. Impact on depression in primary care JAMA, 1995.PMID 7897786
- [14]Katon W, Unützer J, Wells K, Jones L Collaborative depression care: history, evolution and ways to enhance dissemination and sustainability Gen Hosp Psychiatry, 2010.PMID 20851265
- [15]Unutzer J, Katon WJ, Fan MY, et al. Long-term cost effects of collaborative care for late-life depression Am J Manag Care, 2008.PMID 18269305
- [16]Katon W, Von Korff M, Lin E, et al. Collaborative management to achieve depression treatment guidelines J Clin Psychiatry, 1997.PMID 9054905