Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care.
OBJECTIVE
To determine the long term effectiveness of collaborative care management for depression in late life.


METHODS
Two arm, randomised, clinical trial; intervention one year and follow-up two years.


METHODS
18 primary care clinics in eight US healthcare organisations. Patients 1801 primary care patients aged 60 and older with major depression, dysthymia, or both.


METHODS
Patients were randomly assigned to a 12 month collaborative care intervention (IMPACT) or usual care for depression. Teams including a depression care manager, primary care doctor, and psychiatrist offered education, behavioural activation, antidepressants, a brief, behaviour based psychotherapy (problem solving treatment), and relapse prevention geared to each patient's needs and preferences.


METHODS
Interviewers, blinded to treatment assignment, conducted interviews in person at baseline and by telephone at each subsequent follow up. They measured depression (SCL-20), overall functional impairment and quality of life (SF-12), physical functioning (PCS-12), depression treatment, and satisfaction with care.


RESULTS
IMPACT patients fared significantly (P < 0.05) better than controls regarding continuation of antidepressant treatment, depressive symptoms, remission of depression, physical functioning, quality of life, self efficacy, and satisfaction with care at 18 and 24 months. One year after IMPACT resources were withdrawn, a significant difference in SCL-20 scores (0.23, P < 0.0001) favouring IMPACT patients remained.


CONCLUSIONS
Tailored collaborative care actively engages older adults in treatment for depression and delivers substantial and persistent long term benefits. Benefits include less depression, better physical functioning, and an enhanced quality of life. The IMPACT model may show the way to less depression and healthier lives for older adults.
Hunkeler
Enid M
EM
Kaiser Permanente, Division of Research, 2000 Broadway, 2nd Floor, Oakland, CA 94612, USA. emh@dor.kaiser.org
Katon
Wayne
W
Tang
Lingqi
L
Williams
John W
JW
Kroenke
Kurt
K
Lin
Elizabeth H B
EH
Harpole
Linda H
LH
Arean
Patricia
P
Levine
Stuart
S
Grypma
Lydia M
LM
Hargreaves
William A
WA
Unützer
Jürgen
J
D000203:Activities of Daily Living; D000368:Aged; D002908:Chronic Disease; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011320:Primary Health Care; D011613:Psychotherapy / Q000379:methods*; D055502:Secondary Prevention; D016896:Treatment Outcome