Collaborative care and primary care psychiatry — structured clinical viva

Problem diagnosis. Co-location without population registry, serial measurement, or psychiatric caseload review is not Collaborative Care Model fidelity — predicts usual-care-like therapeutic inertia.^[1][2]

Definition. CoCM = team-based primary care mental health with registry, care manager, PCP, psychiatric consultant, measurement-based treatment to target, evidence-based treatments, accountability.^[1]

Ancestor. Wagner Chronic Care Model: proactive team, self-management, decision support, delivery redesign, clinical information systems.^[6]

Evidence elevator pitch. IMPACT late-life depression; Gilbody cumulative MA benefit; Cochrane depression/anxiety benefit; TEAMcare multicondition; telemedicine CoCM (Fortney) for rural PTSD engagement.^{[1][2][3][4][5]}

Build plan. Hire/train care manager; implement PHQ-9/GAD-7 workflow; registry of enrolled patients; weekly caseload review with psychiatrist; protocols for non-response and crisis step-up; fidelity monitoring.^[1]

Safety. Item 9 positive → risk assessment; active plan → crisis pathway, not 6-week routine slot.^[1][2]

Close. Offer to pilot in two practices, measure 6-month PHQ-9 response/remission and process fidelity metrics.^[1][4]