The Bypassing the Blues treatment protocol: stepped collaborative care for treating post-CABG depression.
OBJECTIVE
To present the design of the Bypassing the Blues (BtB) study to examine the impact of a collaborative care strategy for treating depression among patients with cardiac disease. Coronary artery bypass graft (CABG) surgery is one of the most common and costly medical procedures performed in the US. Up to half of post-CABG patients report depressive symptoms, and they are more likely to experience poorer health-related quality of life (HRQoL), worse functional status, continued chest pains, and higher risk of cardiovascular morbidity independent of cardiac status, medical comorbidity, and the extent of bypass surgery.


METHODS
BtB was designed to enroll 450 post-CABG patients from eight Pittsburgh-area hospitals including: (1) 300 patients who expressed mood symptoms preceding discharge and at 2 weeks post hospitalization (Patient Health Questionnaire (PHQ-9) >or=10); and (2) 150 patients who served as nondepressed controls (PHQ-9 <5). Depressed patients were randomized to either an 8-month course of nurse-delivered telephone-based collaborative care supervised by a psychiatrist and primary care expert, or to their physicians' "usual care." The primary hypothesis will test whether the intervention can produce an effect size of >or=0.5 improvement in HRQoL at 8 months post CABG, as measured by the SF-36 Mental Component Summary score. Secondary hypotheses will examine the impact of our intervention on mood symptoms, cardiovascular morbidity, employment, health services utilization, and treatment costs.


RESULTS
Not applicable.


CONCLUSIONS
This effectiveness trial will provide crucial information on the impact of a widely generalizable evidence-based collaborative care strategy for treating depressed patients with cardiac disease.
Rollman
Bruce L
BL
Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. rollmanbl@upmc.edu
Belnap
Bea Herbeck
BH
LeMenager
Michelle S
MS
Mazumdar
Sati
S
Schulberg
Herbert C
HC
Reynolds
Charles F
CF
D000928:Antidepressive Agents / Q000627:therapeutic use; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000523:psychology* / Q000534:rehabilitation; D017281:Cost of Illness; D003863:Depression / Q000188:drug therapy / Q000191:economics / Q000451:nursing / Q000628:therapy*; D003866:Depressive Disorder / Q000188:drug therapy / Q000191:economics / Q000451:nursing / Q000628:therapy*; D006801:Humans; D010348:Patient Care Team; D010353:Patient Education as Topic; D018579:Patient Selection; D011183:Postoperative Complications / Q000188:drug therapy / Q000191:economics / Q000451:nursing / Q000523:psychology / Q000628:therapy*; D011320:Primary Health Care; D011570:Psychiatry; D011788:Quality of Life; D016037:Single-Blind Method; D013689:Telephone; D013903:Thoracic Surgery; D016896:Treatment Outcome; D000092864:Suicide Prevention
D000928:Antidepressive Agents