Collaborative care effective for pain, depression and anxiety

Regenstrief Institute

With the growing prevalence of chronic pain, depression, anxiety, and other symptom-based conditions, physicians and the healthcare systems for which they work are increasingly considering how to augment the care they can provide within the limited time allotted for patient appointments.

According to Regenstrief Institute Research Scientist Kurt Kroenke, M.D., writing in the Journal of General Internal Medicine (JGIM), collaborative care can and should play a major role targeting the treatment of symptoms and functional decline, both too frequently marginalized in medically oriented care delivery.

Collaborative care is a team-based model in which the patient’s primary care physician is assisted in the management of specific health conditions (for example depression, anxiety or pain) by a care manager (often a nurse supervised by a physician specialist) with advanced expertise in the management of those conditions who provides care virtually.

Care managers help patients process information provided by their primary care physicians. For example, care managers can review treatment options, helping patients decide which option they prefer.

“We at Regenstrief and others have extensively studied utilizing collaborative care to provide behavioral treatments, education and care follow-up to patients with depression, anxiety and pain and we have found that it works,” said Dr. Kroenke, a professor of medicine at Indiana University School of Medicine, an internationally respected pioneer in symptomology and the co-developer of the depression and anxiety scales most commonly used in primary care. “Collaborative care works because it provides patients with needed support between physician visits, augmenting medical practice via telephone or another telecare modality, making it easy for patients to fit into their schedules.”

Collaborative care is becoming more common. Dr. Kroenke is currently exploring the use of collaborative care for substance abuse disorders.

“Perhaps the major reason that collaborative care hasn’t gained traction outside of some large, integrated healthcare systems with multiple clinics, is because insurance companies typically have not covered augmenting physician care via telephone,” said Dr. Kroenke. “But this barrier has eroded during the pandemic as telecare has been reimbursed by Medicare as well as insurance companies. And expanded use of telecare during the pandemic has also taught us to deliver virtual care more effectively and efficiently.”

In addition to describing the collaborative care model and highlighting its application to patient care, “Canons of Collaborative Care” by Dr. Kroenke and Andrea Cheville, M.D., of the Mayo Clinic, provides principles for implementing collaborative care in real world clinical practice.

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