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


METHODS
Randomized controlled trial with recruitment from July 1999 to August 2001.


METHODS
Eighteen primary care clinics from 8 health care organizations in 5 states.


METHODS
A total of 1801 patients aged 60 years or older with major depression (17%), dysthymic disorder (30%), or both (53%).


METHODS
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.


METHODS
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<.001). Intervention patients also experienced greater rates of depression treatment (OR, 2.98; 95% CI, 2.34-3.79; P<.001), more satisfaction with depression care (OR, 3.38; 95% CI, 2.66-4.30; P<.001), lower depression severity (range, 0-4; between-group difference, -0.4; 95% CI, -0.46 to -0.33; P<.001), less functional impairment (range, 0-10; between-group difference, -0.91; 95% CI, -1.19 to -0.64; P<.001), and greater quality of life (range, 0-10; between-group difference, 0.56; 95% CI, 0.32-0.79; P<.001) than participants assigned to the usual care group.


CONCLUSIONS
The IMPACT collaborative care model appears to be feasible and significantly more effective than usual care for depression in a wide range of primary care practices.
Unützer
Jürgen
J
Center for Health Services Research, UCLA Neuropsychiatric Institute, 10920 Wilshire Blvd, Suite 300, Los Angeles, CA 90024, USA. unutzer@ucla.edu
Katon
Wayne
W
Callahan
Christopher M
CM
Williams
John W
JW
Hunkeler
Enid
E
Harpole
Linda
L
Hoffing
Marc
M
Della Penna
Richard D
RD
Noël
Polly Hitchcock
PH
Lin
Elizabeth H B
EH
Areán
Patricia A
PA
Hegel
Mark T
MT
Tang
Lingqi
L
Belin
Thomas R
TR
Oishi
Sabine
S
Langston
Christopher
C
D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D019090:Case Management; D003299:Cooperative Behavior; D003866:Depressive Disorder / Q000191:economics / Q000628:therapy*; D005194:Family Practice / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000191:economics; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D011613:Psychotherapy; D011788:Quality of Life; D012944:Social Support; D014481:United States
D000928:Antidepressive Agents