Care management for depression and osteoarthritis pain in older primary care patients: a pilot study.
OBJECTIVE
To establish the feasibility of and to generate preliminary evidence for the efficacy of a care management program addressing both physical and emotional pain associated with late-life depression and osteoarthritis.


METHODS
Treatment development pilot study in three university affiliated primary care clinics. Participants were patients 60 years or older with depression and osteoarthritis pain. The intervention entailed a nurse administered care management program supporting depression and arthritis treatment by primary care physicians. Outcomes include depression, pain severity and functional impairment from pain assessed at baseline and 6 months.


RESULTS
Fourteen patients participated in the pilot program. Between baseline and 6 months, mean HSCL-20 depression scores dropped from 1.78 (SD 0.56) to 1.06 (SD 0.59), a standardized effect size of 1.27 (p = 0.004). Pain intensity scores dropped from 5.67 (SD 1.69) to 4.18 (SD 1.98), an effect size of 0.88 (p = 0.021) and pain interference scores dropped from 4.91 (SD 1.75) to 3.49 (SD 2.14), an effect size of 0.81 (p = 0.013). Patients also experienced improvements in self efficacy, in satisfaction with depression care, and in timed 8-m walk and transfer tests.


CONCLUSIONS
The combined intervention was feasible and well-received by patients. Preliminary outcomes are promising and comparisons to an earlier trial of care management for depression alone suggest that the combined program may be equally effective for depression but more effective for pain.
Unützer
Jürgen
J
University of Washington, Department of Psychiatry & Behavioral Sciences, Seattle, WA, USA.
Hantke
Melinda
M
Powers
Diane
D
Higa
Lori
L
Lin
Elizabeth
E
D Vannoy
Steven
S
Thielke
Stephen
S
Fan
Ming-Yu
MY
D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use*; D018771:Arthralgia / Q000451:nursing / Q000523:psychology / Q000628:therapy*; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000451:nursing / Q000523:psychology / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000451:nursing / Q000523:psychology / Q000628:therapy*; D017060:Patient Satisfaction; D010865:Pilot Projects; D011320:Primary Health Care; D015397:Program Evaluation; D011788:Quality of Life / Q000523:psychology*; D018434:Sickness Impact Profile; D016896:Treatment Outcome
D000928:Antidepressive Agents