In 2015, the State of Colorado was awarded a State Innovation Model (SIM) grant from the Center for Medicare & Medicaid Innovation to integrate behavioral healthcare into 400 primary care practices to reach 80% of the population, with a triple aim framework of better care, lower costs, and improved population health. Colorado is interested in better understanding the connection between behavioral health and chronic disease to better target the SIM initiatives and engage practices undergoing integration to increase their screening rates for depression and chronic diseases.
METHODS:
A mixed-mode, population-based survey (telephone, email, or postal mail) was conducted in 2013-2014 to collect data on behavioral health and chronic disease among Colorado adults. The study sample was drawn from the Colorado Adult Population Sample Survey Research Registry. Data relating to depression, obesity, hypertension, and diabetes were analyzed.
RESULTS:
Of 3,974 survey respondents, 24% reported that they had ever been told by a healthcare provider that they had a depressive disorder, and 37% had ever seen a mental health professional. Of all Colorado residents, only 33% had been asked in the past 12 months if they ever felt sad, blue, or depressed. 59% of Coloradans were estimated to be classified as obese or overweight; 8% had been diagnosed with either type I or II diabetes; and 22% had been told they had hypertension. Among those with hypertension, 40% reported not fully complying with their provider’s self-management plan or having no plan at all. Among those who were obese and referred to specialists, 55% met with either a nutritionist or weight loss program. 48% of people with diabetes were not fully adherent to or had not been given a self-management plan. Common barriers to following these self-management plans included: not wanting to, being too busy, and other concerns. Additional analyses will assess the influence of depression on these chronic conditions and self-management behaviors.
CONCLUSIONS:
Survey data were used to examine interaction between chronic disease and depression. Data were presented to SIM stakeholders, and results were used to provide education to assist in practice transformation, provider education, and population health initiatives.