Promoting Health Equity Through Integrated Care: Implementing Universal Depression Screenings in Coastal Federally Qualified Health Centers
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Abstract
Depression rates in the U.S. continue to rise and create a significant economic burden. Integrating behavioral and mental health into primary care settings is one way to increase depression service delivery including screening, intervention, and follow-up care. Following the 2010 Deepwater Horizon Oil Spill, the Gulf Region Health Outreach Program (GRHOP) was funded with 105 million dollars obtained through a class action lawsuit to build healthcare capacity along the Gulf Coast. Under GRHOP, four Mental and Behavioral Health Capacity Projects (MBHCPs), located in Alabama, Florida, Louisiana, and Mississippi, partnered with 14 Federally Qualified Health Centers (FQHCs) located within the GRHOP footprint to improve healthcare systems and promote integrated behavioral health care. One explicit and shared MBHCP project goal was to increase the rate of depression screenings provided to primary care patients in the targeted FQHCs, as universal screening for depression is a widely accepted marker of behavioral health integration. To determine GRHOP’s impact, annual screening rates were retrieved by accessing the Health Resource and Service Administration’s (HRSA) publicly available Uniform Data System (UDS) reports. Data from 2014 to 2018 were compiled for depression, cervical cancer, and colorectal cancer screening rates. Size- and state-matched comparison clinics were also selected, and data were retrieved for these clinics as well. Comparisons were made both within clinics (over time) and between clinics (GRHOP vs. control clinics) from 2014 to 2018 using paired samples t-tests and analysis of covariance (ANCOVA), respectively. As a secondary aim, the degree to which FQHCs within the GRHOP footprint currently include mental and behavioral health in their mission or vision statements on their websites was also examined. Overall, results indicated that GRHOP clinics significantly increased their rates of depression screenings between 2014 and 2018, indicating an increase in integration. However, these findings were also consistent with changes in screening rates occurring in matched comparison clinics that did not receive funding through GRHOP as well as national depression screening trends. Finally, in terms of mission statements, GRHOP and non-GRHOP clinics did not differ in the number of clinics that advertised mental or behavioral health in their online mission or vision statements. Further, the vast majority of both types of clinics (GRHOP and non-GRHOP) currently advertise in-house mental or behavioral health services. These results suggest that numerous FQHCs throughout the U.S. have begun to screen patients for depressive symptoms and provide on-site behavioral health care, demonstrating a large national movement toward integrated care. While MBHCP clinics experienced substantial shifts in the number of patients screened for depression during the GRHOP funding, these gains may have happened regardless. However, given that FQHCs along the Gulf Coast were known to be substantially under-resourced and were continuing to recover from cumulative natural and man-made disasters, it is possible that GRHOP allowed these clinics to keep pace with their counterparts located in more heavily resourced parts of these states (e.g., Florida panhandle versus Miami area; lower Alabama versus Northern Alabama).