Telephone psychotherapy and telephone care management for primary care patients starting antidepressant treatment: a randomized controlled trial.
BACKGROUND
Both antidepressant medication and structured psychotherapy have been proven efficacious, but less than one third of people with depressive disorders receive effective levels of either treatment.


OBJECTIVE
To compare usual primary care for depression with 2 intervention programs: telephone care management and telephone care management plus telephone psychotherapy.


METHODS
Three-group randomized controlled trial with allocation concealment and blinded outcome assessment conducted between November 2000 and May 2002.


METHODS
A total of 600 patients beginning antidepressant treatment for depression were systematically sampled from 7 group-model primary care clinics; patients already receiving psychotherapy were excluded.


METHODS
Usual primary care; usual care plus a telephone care management program including at least 3 outreach calls, feedback to the treating physician, and care coordination; usual care plus care management integrated with a structured 8-session cognitive-behavioral psychotherapy program delivered by telephone.


METHODS
Blinded telephone interviews at 6 weeks, 3 months, and 6 months assessed depression severity (Hopkins Symptom Checklist Depression Scale and the Patient Health Questionnaire), patient-rated improvement, and satisfaction with treatment. Computerized administrative data examined use of antidepressant medication and outpatient visits.


RESULTS
Treatment participation rates were 97% for telephone care management and 93% for telephone care management plus psychotherapy. Compared with usual care, the telephone psychotherapy intervention led to lower mean Hopkins Symptom Checklist Depression Scale depression scores (P =.02), a higher proportion of patients reporting that depression was "much improved" (80% vs 55%, P<.001), and a higher proportion of patients "very satisfied" with depression treatment (59% vs 29%, P<.001). The telephone care management program had smaller effects on patient-rated improvement (66% vs 55%, P =.04) and satisfaction (47% vs 29%, P =.001); effects on mean depression scores were not statistically significant.


CONCLUSIONS
For primary care patients beginning antidepressant treatment, a telephone program integrating care management and structured cognitive-behavioral psychotherapy can significantly improve satisfaction and clinical outcomes. These findings suggest a new public health model of psychotherapy for depression including active outreach and vigorous efforts to improve access to and motivation for treatment.
Center for Health Studies, Group Health Cooperative, Seattle, Wash 98101, USA. simon.g@ghc.org
Gregory E
GE
Simon
Evette J
EJ
Ludman
Steve
S
Tutty
Belinda
B
Operskalski
Michael
M
Von Korff
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D017216:Telemedicine / Q000379:methods; D013689:Telephone; D016896:Treatment Outcome
D000928:Antidepressive Agents