More Individualized Care: Assessment and Recovery Through Engagement (MI-CARE)

This is an interventional treatment trial for Depression focused on measuring Primary health care, Primary care, Primary care nursing, Evidence-based care, Depressive symptoms, Anxiety disorders and symptoms, Mental Health, Mental Health disorder, Opioid use, Opioid misuse, Opioid use disorder, Opioid dependence, Buprenorphine, Substance use disorders, Overdose, Overdose of opiate, Opioid overdose, Motivational Interviewing, Brief psychotherapy Read More

INCLUSION CRITERIA

Eligible patients must meet all 4 criteria:

1. ≥1 in person or virtual encounter in a primary care setting in the 365 days prior to the data extraction date (pull date);
2. Age ≥18 years at the pull date;
3. ≥1 PHQ-9 depression screening score of ≥10 within the 7 days prior to the pull date.

4. Evidence of potential OUD in the 365 days prior to and including the date of the qualifying PHQ-9 score. Any 1 of the following qualifies as evidence of potential OUD:

   1. ≥1 active OUD ICD-10 diagnosis code in any setting except labs;
   2. ≥1 prescription (orders or dispensed) for buprenorphine (oral formulations indicated for OUD, extended release injectable, and implant);
   3. ≥1 procedure code for buprenorphine (oral formulations indicated for OUD, extended release injectable, and implant);
   4. ≥1 ICD-10 codes for opioid overdose;
   5. ≥1 OUD ICD-10 code, including remission, and prescription (orders or dispensed) or procedure code for injectable naltrexone.

EXCLUSION CRITERIA

Patients are ineligible who meet any of the criteria below:

1. The only indication of OUD or only PHQ available to determine eligibility came from data protected under 42 CFR Part 2;
2. The patient has already been randomized to the trial or was outreached in the pilot study (including outreach to the primary care provider only);
3. English interpreter required (per health system records).

4. Any one of the following conditions in the 2 years prior to and including the date of the qualifying PHQ:

   1. Alzheimer's disease or dementia diagnosis.
   2. Medication to treat Alzheimer's or dementia.

   (b) Severe cognitive limitations.

5. Current active treatment for cancer with chemotherapy or radiation therapy in the past 3 months (not including non-melanoma skin cancers).
6. Previously requested to not participate in research studies at the health system;
7. Documentation of hospice care in the 2 years prior to and including the date of the qualifying PHQ score;
8. Patient is actively being outreached for (or is participating in) depression care management (Kaiser Permanente Washington only)