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- Title
Telephone-delivered collaborative care for treating post-CABG depression: a randomized controlled trial.
- Authors
Rollman BL; Belnap BH; LeMenager MS; Mazumdar S; Houck PR; Counihan PJ; Kapoor WN; Schulberg HC; Reynolds CF 3rd; Rollman, Bruce L; Belnap, Bea Herbeck; LeMenager, Michelle S; Mazumdar, Sati; Houck, Patricia R; Counihan, Peter J; Kapoor, Wishwa N; Schulberg, Herbert C; Reynolds, Charles F 3rd
- Abstract
<bold>Context: </bold>Depressive symptoms commonly follow coronary artery bypass graft (CABG) surgery and are associated with less positive clinical outcomes.<bold>Objective: </bold>To test the effectiveness of telephone-delivered collaborative care for post-CABG depression vs usual physician care.<bold>Design, Setting, and Participants: </bold>Single-blind effectiveness trial at 7 university-based and community hospitals in or near Pittsburgh, Pennsylvania. Participants were 302 post-CABG patients with depression (150, intervention; 152, usual care) and a comparison group of 151 randomly sampled post-CABG patients without depression recruited between March 2004 and September 2007 and observed as outpatients until June 2008.<bold>Intervention: </bold>Eight months of telephone-delivered collaborative care provided by nurses working with patients' primary care physicians and supervised by a psychiatrist and primary care physician from this study.<bold>Main Outcome Measures: </bold>Mental health-related quality of life (HRQL) measured by the Short Form-36 Mental Component Summary (SF-36 MCS) at 8-month follow-up; secondary outcome measures included assessment of mood symptoms (Hamilton Rating Scale for Depression [HRS-D]), physical HRQL (SF-36 PCS), and functional status (Duke Activity Status Index [DASI]); and hospital readmissions.<bold>Results: </bold>The intervention patients reported greater improvements in mental HRQL (all P < or = .02) (SF-36 MCS: Delta, 3.2 points; 95% confidence interval [CI], 0.5-6.0), physical functioning (DASI: Delta, 4.6 points; 95% CI, 1.9-7.3), and mood symptoms (HRS-D: Delta, 3.1 points; 95% CI, 1.3-4.9); and were more likely to report a 50% or greater decline in HRS-D score from baseline (50.0% vs 29.6%; number needed to treat, 4.9 [95% CI, 3.2-10.4]) than usual care patients (P < .001). Men with depression were particularly likely to benefit from the intervention (SF-36 MCS: Delta, 5.7 points; 95% CI, 2.2-9.2; P = .001). However, the mean HRQL and physical functioning of intervention patients did not reach that of the nondepressed comparison group.<bold>Conclusion: </bold>Compared with usual care, telephone-delivered collaborative care for treatment of post-CABG depression resulted in improved HRQL, physical functioning, and mood symptoms at 8-month follow-up.<bold>Trial Registration: </bold>clinicaltrials.gov Identifier: NCT00091962.
- Publication
JAMA: Journal of the American Medical Association, 2009, Vol 302, Issue 19, p2095
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.2009.1670