CoCM Helps Duke Primary Care Meet Standards of Care

Use of the Collaborative Care Model (CoCM) at Duke University began on a pilot basis five years ago, when the University Health System awarded the Department of Psychiatry an innovation grant to establish the model at a handful of primary care sites.

Today the model has been implemented throughout Duke’s primary care system.

Marvin Swartz, M.D., a professor of psychiatry and behavioral health at Duke, said a selling point was that CoCM allowed primary care practices to meet standards of care for depression that require physicians to see a patient within one month of prescribing an antidepressant. As part of the pilot program, Duke had developed its own patient registry, which allows the CoCM team—which typically consists of the primary care physician, behavioral health care manager, and consulting psychiatrist—to track patients’ progress.

Swartz is also director of the Duke Area Health Education Center (AHEC), which is providing training and technical support to practices implementing collaborative care.

“Primary care physicians really liked the model,” he said. “When we presented it to our health system leadership after the success of the pilot, we said we thought it was the only way that primary care could meet standards of care for management of depression. We argued ‘If that’s how we achieve the standard of care, then we need to do it.’ That led to its spreading across Duke’s primary care sites.”

In a state that has one of the fastest growing populations and a small number of psychiatrists who are clustered in urban areas, CoCM is a population health solution to a vast need, Swartz said. “This is a way we can address the shortage in the mental health workforce in an efficient way and be sure all primary care offices have at least this base to meet their needs and can address the large proportion of people with mild to moderate conditions.”

Swartz said that measurement-based care—using scales and validated instruments to assess progress of treatment—and communication of patients’ scores is a great improvement in cross-disciplinary communication.

“Everyone knows what a PHQ-9 is. Primary care physicians typically don’t have the time to weave through a narrative. What they get back from the consulting psychiatrist is an efficient response with not a lot of verbiage.

“Primary care doctors can also know that every one of their patients is evaluated by the behavioral health care manager using a variety of scales,” Swartz continued. “It’s a new language in collaboration.” ■