Effects of Staffing Choices on Collaborative Care for Depression at Primary Care Clinics in Minnesota

Objective: This study assessed associations between staffing of a collaborative care program for depression and enrollment in the program and remission rates. Methods: Data were collected from depression care registries at 63 primary care clinics that participated in the initiative through early 2012. Project leaders at the 12 medical groups that operate the clinics were surveyed about the background of care managers and clinic characteristics. Generalized linear mixed models assessed associations of care manager background and configuration of staffing with enrollment and remission rates. Results: Enrollment was higher (p=.050) and there was a trend toward higher remission rates (p=.105) at clinics where care managers were dedicated exclusively to depression care. No differences in outcomes were obtained by registered nurses versus certified medical assistants and licensed practical nurses. Conclusions: Hiring dedicated paraprofessional care managers may maximize the cost-effectiveness of collaborative care programs and should be supported by regulations and reimbursement policies.