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Arch Fam Med. 2000 Apr;9(4):345-51.

Randomized trial of a depression management program in high utilizers of medical care.

Author information

1
Dean Foundation for Health, Research, and Education, Middleton, Wis., USA. katzelnick_david_j@ssmhc.com

Abstract

BACKGROUND:

High utilizers of nonpsychiatric health care services have disproportionally high rates of undiagnosed or undertreated depression.

OBJECTIVE:

To determine the impact of offering a systematic primary care-based depression treatment program to depressed "high utilizers" not in active treatment.

DESIGN:

Randomized clinical trial.

SETTING:

One hundred sixty-three primary care practices in 3 health maintenance organizations located in different geographic regions of the United States.

PATIENTS:

A group of 1465 health maintenance organization members were identified as depressed high utilizers using a 2-stage telephone screening process. Eligibility criteria were met by 410 patients and 407 agreed to enroll: 218 in the depression management program (DMP) practices and 189 in the usual care (UC) group.

INTERVENTION:

The DMP included patient education materials, physician education programs, telephone-based treatment coordination, and antidepressant pharmacotherapy initiated and managed by patients' primary care physicians.

MAIN OUTCOME MEASURES:

Depression severity was measured using the Hamilton Depression Rating Scale (Ham-D) and functional status using the Medical Outcomes Study 20-item short form (SF-20) subscales. Outpatient visit and hospitalization rates were measured using the health plan's encounter data.

RESULTS:

Based on an intent-to-treat analysis, at least 3 antidepressant prescriptions were filled in the first 6 months by 151 (69.3%) of 218 of DMP patients vs 35 (18.5%) of 189 in UC (P < .001). Improvements in Ham-D scores were significantly greater in the intervention group at 6 weeks (P = .04), 3 months (P = .02), 6 months (P < .001), and 12 months (P < .001). At 12 months, DMP intervention patients were more improved than UC patients on the mental health, social functioning, and general health perceptions scales of the SF-20 (P < .05 for all).

CONCLUSION:

In depressed high utilizers not already in active treatment, a systematic primary care-based treatment program can substantially increase adequate antidepressant treatment, decrease depression severity, and improve general health status compared with usual care.

Comment in

PMID:
10776363
DOI:
10.1001/archfami.9.4.345
[Indexed for MEDLINE]

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