Reduction of patient-reported antidepressant side effects, by type of collaborative care.
OBJECTIVE
Antidepressants are effective for treating depression, and collaborative care increases initiation of and adherence to antidepressants. Side effects of antidepressants are common and can adversely affect quality of life. Care managers address antidepressant side effects directly, but the impact of collaborative care on adverse effects is unknown. This secondary data analysis tested the hypothesis that patient-reported antidepressant side effects were lower for depressed patients receiving high-intensity, telemedicine-based collaborative care (TBCC) than for patients receiving low-intensity, practice-based collaborative care (PBCC).


METHODS
This analysis used data from 190 patients enrolled in a pragmatic, multisite, comparative-effectiveness trial from 2007 to 2009 and followed for 18 months. Most patients were female (83%) and Caucasian (80%). The mean age was 50. Patients randomly assigned to PBCC received 12 months of evidence-based care from an on-site primary care provider and nurse care manager. Patients in TBCC received evidence-based care from an on-site primary care provider supported by a nurse care manager available off site by telephone, as well as by a telepharmacist, telepsychologist, and telepsychiatrist. Telephone interviews completed at baseline, six, 12, and 18 months included assessments of sociodemographic characteristics, beliefs about antidepressant treatment, depression severity, psychiatric comorbidity, medications, adherence, and side effects.


RESULTS
With controls for baseline case mix and time-variant medication characteristics, the TBCC group reported significantly fewer side effects at six and 12 months (p=.008 and .002, respectively). The number of antidepressants prescribed increased risk of side effects (p=.02).


CONCLUSIONS
Patients in the TBCC group reported fewer antidepressant-related side effects, which may have contributed to improved quality of life.
The authors are with the Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock (e-mail: teresa.hudson@va.gov ). Except for Ms. Lu, the authors are also with Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock. A similar draft of this article was based on a slightly different analytic model and was presented in a poster titled "Improving Health Through Research and Training" at the Translational Science meeting, Washington, D.C., April 18-20, 2012.
Teresa J
TJ
Hudson
John C
JC
Fortney
Jeffrey M
JM
Pyne
Liya
L
Lu
Dinesh
D
Mittal
D000928:Antidepressive Agents / Q000009:adverse effects*; D003299:Cooperative Behavior; D003866:Depressive Disorder / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods*; D017216:Telemedicine / Q000379:methods*
D000928:Antidepressive Agents