Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial

Journal Name: 
JAMA
Authors: 
Unutzer,J.
Katon,W.
Callahan,C.M.
Williams,J.W.
Hunkeler,E.
Harpole,L.
Hoffing,M.
Della Penna,R.D.
Noel,P.H.
Lin,E.H.
Arean,P.A.
Hegel,M.T.
Tang,L.
Belin,T.R.
Oishi,S.
Langston,C.
Abstract: 
CONTEXT: Few depressed older adults receive effective treatment in primary care settings. OBJECTIVE: To determine the effectiveness of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) collaborative care management program for late-life depression. DESIGN: Randomized controlled trial with recruitment from July 1999 to August 2001. SETTING: Eighteen primary care clinics from 8 health care organizations in 5 states. PARTICIPANTS: A total of 1801 patients aged 60 years or older with major depression (17%), dysthymic disorder (30%), or both (53%). INTERVENTION: Patients were randomly assigned to the IMPACT intervention (n = 906) or to usual care (n = 895). Intervention patients had access for up to 12 months to a depression care manager who was supervised by a psychiatrist and a primary care expert and who offered education, care management, and support of antidepressant management by the patient's primary care physician or a brief psychotherapy for depression, Problem Solving Treatment in Primary Care. MAIN OUTCOME MEASURES: Assessments at baseline and at 3, 6, and 12 months for depression, depression treatments, satisfaction with care, functional impairment, and quality of life. RESULTS: At 12 months, 45% of intervention patients had a 50% or greater reduction in depressive symptoms from baseline compared with 19% of usual care participants (odds ratio [OR], 3.45; 95% confidence interval [CI], 2.71- 4.38; P
12
11
2002
Volume: 
288
Pages: 
2836-45
Keywords: 
3680, 60, ACCESS, Adult, Aged, antidepressant, Antidepressive Agents: therapeutic use, Case Management, CHCN, Cooperative Behavior, Depression, depressive, Depressive Disorder: economics: therapy, education, Family Practice: economics: organization & administration: standards, Female, Health, health care, Health Services Accessibility, Health Services Research, Human, intervention, Life, Male, Mental Health Services: economics: organization & administration: standards, Odds Ratio, older, Organizations, Outcome and Process Assessment (Health Care), patient, Patient Care Team: economics, Patient Education, Patient Satisfaction, Patients, primary care, Primary Health Care: organization & administration: standards, Psychotherapy, quality, Quality of Life, Social Support, support, Support,Non-U.S.Gov't, United States