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J Gen Intern Med. 2002 Oct;17(10):741-8.

Long-term effects of a collaborative care intervention in persistently depressed primary care patients.

Author information

1
Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Seattle, Wash 98195, USA. wkaton@u.washington.edu

Abstract

OBJECTIVE:

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.

DESIGN:

Randomized trial of stepped collaborative care intervention versus usual care.

SETTING:

HMO in Seattle, Wash.

PATIENTS:

Patients with major depression were stratified into severe and moderate depression groups prior to randomization.

INTERVENTIONS:

A multifaceted intervention targeting patient, physician, and process of care, using collaborative management by a psychiatrist and a primary care physician.

MEASURES AND MAIN RESULTS:

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).

CONCLUSIONS:

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.

PMID:
12390549
PMCID:
PMC1495114
DOI:
10.1046/j.1525-1497.2002.11051.x
[Indexed for MEDLINE]
Free PMC Article

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