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: 2.9). 03/2006; 28(2):101-7. DOI: 10.1016/j.genhosppsych.2005.10.008
Source: PubMed

ABSTRACT 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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    • "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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