A Primary Care Program for Patients with Complex Chronic Disease and Depression. Paul Ciechanowski, MD, MPH Associate Professor, Dept. of Psychiatry Team Psychiatrist, UW Diabetes Care Center Director UW Center for Training University of Washington, Seattle, Washington

1. Consumer-Centric Health Models for Change ‘11 Logo, etc

2. Paul Ciechanowski, MD, MPH Associate Professor, Dept. of Psychiatry Team Psychiatrist, UW Diabetes Care Center Director UW Center for Training University of Washington, Seattle, Washington TEAMcare A Primary Care Program for Patients with Complex Chronic Disease and Depression

3. Presenter Disclosure Paul Ciechanowski, MD, MPH Founder of Samepage (samepage.org)

4. The Problem (?)

6. It gets worse…

7. Mr. T. Primary complaint: ongoing fatigue PHQ-9 = 19/27: meets criteria for major depression

11. The Real Problem?

12. JAMA, April 7, 2010 The “ Multi-Condition” Patient

14. A Solution

15. PRIMARY CARE PROVIDER AND TEAM PSYCHIATRIC SUPERVISION PATIENT NURSE CASE MANAGER Collaborative Care

17. But, it gets better…

18. TEAMcare Clinical Trial & Program “ Multi-Condition Collaborative Care” for chronic conditions & depression to address: A 1c B lood pressure C holesterol (LDL) D epression

23. A B C D

24. A 1c B lood pressure C holesterol (LDL) D epression

26. The Secret Sauce?

27. PRIMARY CARE PROVIDER AND TEAM PSYCHIATRIC/ BEHAVIORAL & MEDICAL SUPERVISION PATIENT NURSE CASE MANAGER

28. PRIMARY CARE PROVIDER AND TEAM PSYCHIATRIC/ BEHAVIORAL & MEDICAL SUPERVISION PATIENT NURSE CASE MANAGER

32. Problem Solving Treatment

33. FEEL BAD e.g. feeling depressed DO LESS e.g. stay inside, withdraw from friends, dwell on problems

34. PRIMARY CARE PROVIDER AND TEAM PSYCHIATRIC/ BEHAVIORAL & MEDICAL SUPERVISION PATIENT NURSE CASE MANAGER

39. Any Medication Adjustment

40. PRIMARY CARE PROVIDER AND TEAM PSYCHIATRIC/ BEHAVIORAL & MEDICAL SUPERVISION PATIENT NURSE CASE MANAGER

45. teamcarehealth.org