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- Title
Long-term effects of a collaborative care intervention in persistently depressed primary care patients.
- Authors
Katon, Wayne; Russo, Joan; Von Korff, Michael; Lin, Elizabeth; Simon, Greg; Bush, Terry; Ludman, Evette; Walker, Edward
- Abstract
<bold>Objective: </bold>A previous study described the effect of a collaborative care intervention on improving adherence to antidepressant medications and depressive and functional outcomes of patients with persistent depressive symptoms 8 weeks after the primary care physician initiated treatment. This paper examined the 28-month effect of this intervention on adherence, depressive symptoms, functioning, and health care costs.<bold>Design: </bold>Randomized trial of stepped collaborative care intervention versus usual care.<bold>Setting: </bold>HMO in Seattle, Wash.<bold>Patients: </bold>Patients with major depression were stratified into severe and moderate depression groups prior to randomization.<bold>Interventions: </bold>A multifaceted intervention targeting patient, physician, and process of care, using collaborative management by a psychiatrist and a primary care physician.<bold>Measures and Main Results: </bold>The collaborative care intervention was associated with continued improvement in depressive symptoms at 28 months in patients in the moderate-severity group (F1,87 = 8.65; P =.004), but not in patients in the high-severity group (F1,51 = 0.02; P =.88) Improvements in the intervention group in antidepressant adherence were found to occur for the first 6 months (chi2(1) = 8.23; P <.01) and second 6-month period (chi2(1) = 5.98; P <.05) after randomization in the high-severity group and for 6 months after randomization in the moderate-severity group(chi2(1) = 6.10; P <.05). There were no significant differences in total ambulatory costs between intervention and control patients over the 28-month period (F1,180 = 0.77; P =.40).<bold>Conclusions: </bold>A collaborative care intervention was associated with sustained improvement in depressive outcomes without additional health care costs in approximately two thirds of primary care patients with persistent depressive symptoms.
- Subjects
MENTAL depression; THERAPEUTICS; PRIMARY care
- Publication
JGIM: Journal of General Internal Medicine, 2002, Vol 17, Issue 10, p741
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1046/j.1525-1497.2002.11051.x