Taking an evidence-based model of depression care from research to practice: Making lemonade out of depression. General Hospital Psychiatry, 28, 101-107

San Diego State University, San Diego, California, United States
General Hospital Psychiatry (Impact Factor: 2.61). 03/2006; 28(2):101-7. DOI: 10.1016/j.genhosppsych.2005.10.008
Source: PubMed


The Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) trial [randomized controlled trial (RCT)] found that collaborative care management of depression in older primary care patients was significantly more effective than the usual care. We examined how an adapted version of IMPACT is working in the "real-world" setting of an HMO 3 years after the conclusion of the trial.
Two hundred ninety-seven adults treated according to IMPACT protocol "poststudy" (PS) at a large group model HMO were compared to the 141 participants (historical control) in the intervention arm of the RCT at the same site. The Patient Health Questionnaire (PHQ-9) was used to compare depression severity at baseline and 6 months. We also compared treatment contacts, use of antidepressants and psychotherapy and total health care costs.
The RCT and PS groups were equivalent regarding baseline depression scores (14.5 vs. 14.2, P=.72), 6-month scores (5.6 vs. 6.3, P=.28) and percent experiencing 50% improvement in depression (68% vs. 70%, P=.83). Antidepressant use was similar (85% and 90%, P=.57). Treatment contacts were fewer in PS than RCT (14 vs. 20, P<.001).
An adapted version of the IMPACT program implemented at a large HMO achieved similar clinical improvements in depression as the clinical trial despite a lower number of intervention contacts.

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    • "These results are consistent with those found for the IMPACT randomized controlled trial and posttrial intervention with older adults which found 6-month reduction rates of 5.6 and 6.3 points, respectively, in PHQ-9 severity scores [20]. It is important to note that, unlike some randomized controlled trials (RCTs) of depression care management (e.g., [21, 22]), the current study cohort was not limited to first episodes of depression, but included persons with recurrent, chronic, and treatment-resistant depression. Also, members who screened positive for psychiatric comorbidities were not excluded in this evaluation. "
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    ABSTRACT: The authors describe the implementation of a depression care management (DCM) program at Colorado Access, a public sector health plan, and describe the program's clinical and system outcomes for members with chronic medical conditions. High medical risk, high cost Medicaid health plan members were identified and systematically screened for depression. A total of 370 members enrolled in the DCM program. Longitudinal analyses revealed significantly reduced depression severity scores at 3, 6, and 12 months after intervention as compared to baseline depression scores. At 12 months, 56% of enrollees in the DCM program had either a 50% reduction in PHQ-9 scores or a PHQ-9 score < 10. Longitudinal economic analyses comparing 12 months before and after intervention revealed a significant but modest increase in ER visits, outpatient office visits, and overall medical and pharmacy costs when adjusted for months enrolled in DCM. Limitations and recommendations for the integrated depression care management are discussed.
    Depression research and treatment 10/2012; 2012:769298. DOI:10.1155/2012/769298
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    • "further documentation . The models of integration varied in who ( primary care physician or mental health specialist ) assumed primary decision - making authority for patient care . Three patterns were observed . Twelve trials used coordi - nated decision - making practices ( Asarnow et al . , 2005 ; Clarke et al . , 2005 ; Finley et al . , 2003 ; Grypma et al . , 2006 ; Hilty et al . , 2007 ; Hunkeler et al . , 2006 ; Katon et al . , 1996 , 2001 , 2003 , 2004 ; Simon et al . , 2004 ; Un - utzer et al . , 2001 ) . Twelve trials had the pri - mary care clinician principally responsible for care , with the assistance of care management and specialty mental health clinicians as sup - port ( Adler et al ."
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    ABSTRACT: Care management-based interventions promoting integrated care by combining primary care with mental health services in a coordinated and colocated manner are increasingly popular; yet, the benefits of specific approaches are not well established. We conducted a systematic review of integrated care trials in US primary care settings to assess whether the level of integration of provider roles or care process affects clinical outcomes. Although most trials showed positive effects, the degree of integration was not significantly related to depression outcomes. Integrated care appears to improve depression management in primary care patients, but questions remain about its specific form and implementation.
    The Journal of ambulatory care management 04/2011; 34(2):113-25. DOI:10.1097/JAC.0b013e31820ef605
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    ABSTRACT: To assess the clinical and economic impact of a pharmacist-focused health management program for patients with depression. Prospective, nonrandomized, proof-of-concept investigation. Asheville, NC, from July 2006 through December 2007. Employees or adult dependents with depressive symptoms who agreed to enroll in an employer-sponsored treatment program conducted at two ambulatory clinics where consultative services were provided. Participants were included in the analysis if they participated in the program for at least 1 year and had two or more documented visits with a pharmacist. Outpatient-based pharmacists provided assessment, self-management services follow-up, and treatment recommendations to primary care providers within a collaborative care management model. Changes in severity of depressive symptoms and impact on overall health care costs for employers and beneficiaries. Of the 151 beneficiaries referred to the program, 130 (82%) remained under pharmacist care for a minimum of 1 year and were included in the aggregate analysis. Statistically significant improvements were observed for Patient Health Questionnaire (PHQ)-9 scores from baseline to endpoint (11.5 ± 6.6 to 5.3 ± 4.7 [mean ± SD], P < 0.0001). The clinical response rate was 68% with a 56% remission rate. In economic subgroup analysis (n = 48), annual medical costs decreased from an average of $6,351 per enrollee to $5,876, which was lower than the projected value ($7,195). Total health care costs to the employer increased from $7,935 per enrollee to $8,040, which was lower than the projected value ($9,023). Patients in the first year of the program had significant improvement in the PHQ-9 clinical indicator of depression severity. Total health care costs per patient per year were reduced compared with projected costs without the program. Employers expressed their appreciation for this collaborative care program and continued to offer this voluntary health benefit after the study's conclusion.
    Journal of the American Pharmacists Association 01/2011; 51(1):40-9. DOI:10.1331/JAPhA.2011.09147 · 1.24 Impact Factor
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