Remission in depressed geriatric primary care patients: a report from the PROSPECT study.
OBJECTIVE
This study compared time to first remission for elderly depressed patients in primary care for practices that implemented a care management model versus those providing usual care. In addition, it sought to identify risk factors for nonremission that could guide treatment planning and referral to care managers or specialists.


METHODS
Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) data were analyzed. Participants were older patients (> or =60 years) selected following screening of 9,072 randomly identified primary care patients. The present analysis examined patients with major depression and a 24-item Hamilton Depression Rating Scale score of 18 or greater who were followed for at least 4 months (N=215). Primary care practices were randomly assigned to offer the PROSPECT intervention or usual care. The intervention consisted of services of trained care managers, who offered algorithm-based recommendations to physicians and helped patients with treatment adherence over 18 months.


RESULTS
First remission occurred earlier and was more common among patients receiving the intervention than among those receiving usual care. For all patients, limitations in physical and emotional functions predicted poor remission rate. Patients experiencing hopelessness were more likely to achieve remission if treated in intervention practices. Similarly, the intervention was more effective in patients with low baseline anxiety.


CONCLUSIONS
Longitudinal assessment of depression, hopelessness, anxiety, and physical and emotional functional limitations in depressed older primary care patients is critical. Patients with prominent symptoms or impairment in these areas may be candidates for care management or mental health care, since they are at risk for remaining depressed and disabled.
Alexopoulos
George S
GS
Department of Psychiatry, Weill Medical College of Cornell University, New York, USA. gsalexop@med.cornell.edu
Katz
Ira R
IR
Bruce
Martha L
ML
Heo
Moonseong
M
Ten Have
Thomas
T
Raue
Patrick
P
Bogner
Hillary R
HR
Schulberg
Herbert C
HC
Mulsant
Benoit H
BH
Reynolds
Charles F
CF
D000368:Aged; D000465:Algorithms; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D006299:Health Services for the Aged / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010346:Patient Care Management / Q000379:methods*; D010347:Patient Care Planning; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods*; D011336:Probability; D011569:Psychiatric Status Rating Scales; D012017:Referral and Consultation; D012107:Research Design / Q000592:standards; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States; D016270:United States Agency for Healthcare Research and Quality / Q000592:standards