Telephone-delivered collaborative care for treating post-CABG depression: a randomized controlled trial.
BACKGROUND
Depressive symptoms commonly follow coronary artery bypass graft (CABG) surgery and are associated with less positive clinical outcomes.


OBJECTIVE
To test the effectiveness of telephone-delivered collaborative care for post-CABG depression vs usual physician care.


METHODS
Single-blind effectiveness trial at 7 university-based and community hospitals in or near Pittsburgh, Pennsylvania. Participants were 302 post-CABG patients with depression (150, intervention; 152, usual care) and a comparison group of 151 randomly sampled post-CABG patients without depression recruited between March 2004 and September 2007 and observed as outpatients until June 2008.


METHODS
Eight months of telephone-delivered collaborative care provided by nurses working with patients' primary care physicians and supervised by a psychiatrist and primary care physician from this study.


METHODS
Mental health-related quality of life (HRQL) measured by the Short Form-36 Mental Component Summary (SF-36 MCS) at 8-month follow-up; secondary outcome measures included assessment of mood symptoms (Hamilton Rating Scale for Depression [HRS-D]), physical HRQL (SF-36 PCS), and functional status (Duke Activity Status Index [DASI]); and hospital readmissions.


RESULTS
The intervention patients reported greater improvements in mental HRQL (all P < or = .02) (SF-36 MCS: Delta, 3.2 points; 95% confidence interval [CI], 0.5-6.0), physical functioning (DASI: Delta, 4.6 points; 95% CI, 1.9-7.3), and mood symptoms (HRS-D: Delta, 3.1 points; 95% CI, 1.3-4.9); and were more likely to report a 50% or greater decline in HRS-D score from baseline (50.0% vs 29.6%; number needed to treat, 4.9 [95% CI, 3.2-10.4]) than usual care patients (P < .001). Men with depression were particularly likely to benefit from the intervention (SF-36 MCS: Delta, 5.7 points; 95% CI, 2.2-9.2; P = .001). However, the mean HRQL and physical functioning of intervention patients did not reach that of the nondepressed comparison group.


CONCLUSIONS
Compared with usual care, telephone-delivered collaborative care for treatment of post-CABG depression resulted in improved HRQL, physical functioning, and mood symptoms at 8-month follow-up.


BACKGROUND
clinicaltrials.gov Identifier: NCT00091962.
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
Houck
Patricia R
PR
Counihan
Peter J
PJ
Kapoor
Wishwa N
WN
Schulberg
Herbert C
HC
Reynolds
Charles F
CF
D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D003266:Continuity of Patient Care; D001026:Coronary Artery Bypass / Q000523:psychology*; D003863:Depression / Q000209:etiology / Q000628:therapy*; D003866:Depressive Disorder / Q000209:etiology / Q000628:therapy*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D010353:Patient Education as Topic; D016037:Single-Blind Method; D017216:Telemedicine; D013689:Telephone
D000928:Antidepressive Agents