Our Starting Point
In June 2015, healthcare providers at the MetroHealth System (MHS) HIV Clinic began implementing a collaborative care approach with the intention of identifying and treating depressive symptoms among people living with HIV. This approach has been used in other primary care settings to bridge the gap in depression care and has been shown to improve access to care, processes, and outcomes. This MIDUS model implementation guide explores some of the unique challenges and adaptations needed to address the needs of people living with HIV.
Patients were screened annually in the clinic for depressive symptoms using the Patient Health Questionnaire (PHQ-2/PHQ-9) as a part of the patients’ health maintenance items. Patients reporting a score of 10 or higher met with a behavioral health care manager (BHM) during the clinic visit. The BHM worked with the patient to better understand their symptoms, identify self-management strategies to address these symptoms, and complete a diagnostic assessment. The BHM also worked with a consulting psychiatrist (CP) to confirm a diagnosis and develop a treatment plan, which was then carried out by the HIV physician and monitored by the BHM.
A typical referral appointment for a mental health evaluation from a psychiatrist may take months. This model decreases the timeline from evaluation to recommendation for treatment to one to two weeks.