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Assessment and Management of Depression, Anxiety, and Alcohol Problems in Primary Care: The BHL Program

Development of a Sustainable Clinical Innovation

Development Principals

  • Adaptability

  • Efficiency

  • Targets need

  • Scalable

Inception Key issues

BHL Clinical Process

Inception Other issues

  • Scalability

  • Ease of use

  • Interface with CPRS

Initial Beta Version

  • Small scale: self programmed in access

  • Limited features: interview only, expanded to registration function

  • Enrollment: partnership with primary care around screening

Contracting out

  • No to CPRS integration – a big decision

  • Interviewing software firms

  • Developing design features for the programming: scalability, integration of change, building on

  • Development of a mechanism to track, test, and deploy changes

Quality Control

  • Data: range checks, limited input, limited capacity to change values (administrator)

  • Input: staff training

  • Acceptability: provider use, patient satisfaction, completion rates

  • Algorithms: comparison to clinical interviews, randomized trials of key components, long term outcomes

  • Program: EPRP measures, acceptability, management

Core Assessment Module

  • During the last 12 months

    • 3779 patients were referred (from 2 VAMCs)
    • 81.7% had a complete assessment
        • PTSD (84%)
        • Alcohol or drug problems (73%).
        • no differences in completion rates between the Medical Center and CBOCs.

Treatment Components

  • Core Assessment – comprehensive

  • Depression Module

    • 2, 6, 9 Weeks
    • Adherence, Depressive symptoms, Side effects
  • Watchful Waiting

  • Alcohol Brief intervention and followup

  • Referral management

Addressing Quality Indicators

Web Resources

  • (Behavioral Health Laboratory)

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