Effectiveness of disease management programs in depression: a systematic review.
OBJECTIVE
The authors systematically evaluated the published evidence to assess the effectiveness of disease management programs in depression.


METHODS
English-language articles on depression were identified through a MEDLINE search for the period from January 1987 to June 2001. Two reviewers evaluated 16,952 published titles, identified 24 depression disease management programs that met explicit inclusion criteria, and extracted data on study characteristics, interventions used, and outcome measures. Pooled effect sizes were calculated by using a random-effects model.


RESULTS
Pooled results for disease management program effects on symptoms of depression showed statistically significant improvements (effect size=0.33, N=24). Programs also had statistically significant effects on patients' satisfaction with treatment (effect size=0.51, N=6), patients' compliance with the recommended treatment regimen (effect size=0.36, N=7), and adequacy of prescribed treatment (effect size=0.44, N=11). One program with an explicit screening component showed significant improvement in the rate of detection of depression by primary care physicians (effect size=0.66); two other programs lacking a screening component showed small nonsignificant improvements in the detection rate (effect size=0.18). Disease management programs increased health care utilization (effect size=-0.10, N=8), treatment costs (effect size=-1.03, N=3), and hospitalization (effect size=-0.20, N=2).


CONCLUSIONS
Disease management appears to improve the detection and care of patients with depression. Further research is needed to assess the cost-effectiveness of disease management in depression, and consideration should be given to more widespread implementation of these programs.
Badamgarav
Enkhe
E
Zynx Health, 9100 Wilshire Blvd., East Tower, Suite 655, Beverly Hills, CA 90212, USA. ebadamgarav@cerner.com
Weingarten
Scott R
SR
Henning
James M
JM
Knight
Kevin
K
Hasselblad
Vic
V
Gano
Anacleto
A
Ofman
Joshua J
JJ
D002908:Chronic Disease; D003866:Depressive Disorder / Q000175:diagnosis / Q000628:therapy*; D019468:Disease Management; D006801:Humans; D010043:Outcome and Process Assessment, Health Care