Improving Mental Health and Addressing Mental Illness: Collaborative Care for the Management of Depressive Disorders, Definitions of Terms

Concordance is the degree to which a healthcare provider follows evidence-based guidelines/protocols/algorithms for treatment or interventions.

Collaboration refers to interaction/communication among providers and between providers and clients/consumers/patients intended to facilitate participation and clarification of health-related goals.

Case Management is a collaborative process of assessment, planning, facilitation and advocacy to maintain a continuous and coordinated process of care (Case Management Society of America).

Adherence is the client/consumer/patient administration of therapies in a manner consistent with an agreed upon treatment plan.

Case Manager is an individual provider whose role is to interact with other providers and with clients/consumers/patients for management, coordination and continuity of care.

Primary Healthcare Provider is a healthcare provider with broad medical responsibility for clients/consumers/patients and who often serves as the first healthcare system point-of-contact.

Mental Health Specialist – a healthcare professional with specialized training and expertise in the treatment and/or management of mental health disorders and other mental health issues.

Screening is a brief process to identify persons in the community at high risk for depressive symptoms/disorders requiring further assessment or management.

Client/Consumer/Patient is an individual in the healthcare system who might have depressive symptoms and may or may not be diagnosed as having a depressive disorder.

Community is a group of stakeholders at any level and from all backgrounds (e.g. clients/consumers/patients, families, healthcare providers, case managers) sharing an environment (e.g. health system, living areas, worksites, schools, colleges).

Health system is a network that is inclusive of all activities and whose primary purpose is to promote, restore or maintain health (World Health Organization).

System support is a sustained supply of services and material necessary for the use and improvement of a system.

Goal clarification is an intended product of the processes of collaboration and care management in order to allow patients/consumers/clients to participate, to be informed and updated with respect to their health-related goals.

Recommendation outcomes:

• Proportion of population screened is coverage of screening for depressive symptoms/disorders among the target population
• Response is a 50% or greater reduction in depressive symptoms from baseline (Rush et al 2006)
• Remission is improvement of symptoms for 3 successive weeks such that the individual no longer meets the diagnostic criteria for a depressive disorder and has minimal symptoms at most (Rush et al. 2006)
• Recovery is an improvement in depressive symptoms, such that the individual no longer meets the diagnostic criteria for a depressive disorder that is sustained for 4 months after achieving remission (Rush et al. 2006)
• Functional Status is the extent to which an individual can perform normal daily activities required to meet basic needs, fulfill usual roles, and maintain health and well-being (American Thoracic Society)
• Quality of Life is “an individual's or group’s perceived physical and mental health over time” (CDC)

Other outcome(s):

• Satisfaction with care is “a patient’s perception of the quality of healthcare providers, access to services, communication with providers and administrative staff, and of the success of their treatment” (Cherin et al 2001; Rapkin et al 2008)

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References

American Thoracic Society. Functional Status. http://www.thoracic.org.

Case Management Society of America. Definition of Case Management. http://www.cmsa.org/ABOUTUS/DefinitionofCaseManagement/tabid/104/Default.aspx [accessed 03/12/2008]

CDC. Health-Related Quality of Life – Definition. Measuring Healthy Days – Population Assessment of Health-Related Quality of Life. U.S. Department of Health and Human Services. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Division of Adult and Community Health. November 2000.

Cherin DA, Huba GJ, Steinberg J, Reis P, Melchior LA, Panter AT. Satisfaction with services in innovative managed care programs for groups of traditionally underserved individuals with HIV/AIDS: empirical models. Home Health Care Serv Q 2001;19(1-2):103-25.

Rapkin B, Weiss E, Chhabra R, Ryniker L, Patel S, Carness J, Adsuar R, Kahalas W, Delamarter C, Feldman I, Delorenzo J, Tanner E. Beyond satisfaction: using the dynamics of care assessment to better understand patients' experiences in care. Health Qual Life Outcomes 2008;6(1):20.

Rush AJ, Kraemer HC, Sackeim HA, Fava M, Trivedi MH, Frank E, Ninan PT, Thase ME, Gelenberg AJ, Kupfer DJ, Regier DA, Rosenbaum JF, Ray O, Schatzberg AF. Report by the ACNP Task Force on Response and Remission in Major Depressive Disorder. Neuropsychopharmacology 2006;31:1841–53.

The World Health Organization. The World Health Report 2000 – Health Systems: Improving Performance. http://www.who.int/whr/2000/en/whr00_ch1_en.pdf [accessed 03/12/2008]