PURPOSE Depression commonly accompanies diabetes, resulting in reduced adherence to medications and increased risk for morbidity and mortality. The objective of this study was to examine whether a simple, brief integrated approach to depression and type 2 diabetes mellitus (type 2 diabetes) treatment improved adherence to oral hypoglycemic agents and antidepressant medications, glycemic control, and depression among primary care patients. METHODSWe undertook a randomized controlled trial conducted from April 2010 through April 2011 of 180 patients prescribed pharmacotherapy for type 2 diabetes and depression in primary care. Patients were randomly assigned to an integrated care intervention or usual care. Integrated care managers collaborated with physicians to offer education and guideline-based treatment recommendations and to monitor adherence and clinical status. Adherence was assessed using the Medication Event Monitoring System (MEMS). We used glycated hemoglobin (HbA 1c ) assays to measure glycemic control and the 9-item Patient Health Questionnaire (PHQ-9) to assess depression. RESULTSIntervention and usual care groups did not differ statistically on baseline measures. Patients who received the intervention were more likely to achieve HbA 1c levels of less than 7% (intervention 60.9% vs usual care 35.7%; P <.001) and remission of depression (PHQ-9 score of less than 5: intervention 58.7% vs usual care 30.7%; P <.001) in comparison with patients in the usual care group at 12 weeks.CONCLUSIONS A randomized controlled trial of a simple, brief intervention integrating treatment of type 2 diabetes and depression was successful in improving outcomes in primary care. An integrated approach to depression and type 2 diabetes treatment may facilitate its deployment in real-world practices with competing demands for limited resources. INTRODUCTIONA bidirectional association has been found between depression and diabetes mellitus.1 Depression is a risk factor for diabetes, 2 and diabetes increases risk for the onset of depression.3 Not only is depression common in patients with diabetes, it also contributes to poor adherence to medication and dietary regimens, physical inactivity, poor glycemic control, reduced quality of life, disability, and increased health care expenditures. 4-9The purpose of this study was to carry out a randomized controlled trial to test the effectiveness of integrated care management of type 2 diabetes mellitus (type 2 diabetes) and depression in comparison with usual

Purpose The purpose of this study was to examine whether integrating depression treatment into care for Type 2 diabetes mellitus among older African-Americans improved medication adherence, glycemic control, and depression outcomes. Methods Older African-Americans prescribed pharmacotherapy for Type 2 diabetes mellitus and depression from physicians at a large primary care practice in West Philadelphia were randomly assigned to an integrated care intervention or usual care. Adherence was assessed at baseline, 2, 4, and 6 weeks using the Medication Event Monitoring System (MEMS) to assess adherence. Outcomes assessed at baseline and 12 weeks included standard laboratory tests to measure glycemic control and the Center Epidemiologic Studies Depression Scale (CES-D) to assess depression. Results In all, 58 participants aged 50 to 80 years participated. The proportion of participants who had 80% or greater adherence to an oral hypoglycemic (intervention 62.1% vs. usual care 24.1%) and an antidepressant (intervention 62.1% vs. usual care 10.3%) was greater in the intervention group in comparison with the usual care group at 6 weeks. Participants in the integrated care intervention had lower levels of glycosylated hemoglobin (intervention 6.7% vs. usual care 7.9%) and fewer depressive symptoms (CES-D mean scores, intervention 9.6 vs. usual care 16.6) compared with participants in the usual care group at 12 weeks. Conclusion A pilot randomized controlled trial integrating Type 2 diabetes mellitus treatment and depression was successful in improving outcomes among older African-Americans. Integrated interventions may be more feasible and effective in real world practices with competing demands for limited resources.

PURPOSE We wanted to examine whether integrating depression treatment into care for hypertension improved adherence to antidepressant and antihypertensive medications, depression outcomes, and blood pressure control among older primary care patients. METHODSOlder adults prescribed pharmacotherapy for depression and hypertension from physicians at a large primary care practice in West Philadelphia were randomly assigned to an integrated care intervention or usual care. Outcomes were assessed at baseline, 2, 4, and 6 weeks using the Center for Epidemiologic Studies Depression Scale (CES-D) to assess depression, an electronic monitor to measure blood pressure, and the Medication Event Monitoring System to assess adherence. RESULTSIn all, 64 participants aged 50 to 80 years participated. Participants in the integrated care intervention had fewer depressive symptoms (CES-D mean scores, intervention 9.9 vs usual care 19.3; P <.01), lower systolic blood pressure (intervention 127.3 mm Hg vs usual care 141.3 mm Hg; P <.01), and lower diastolic blood pressure (intervention 75.8 mm Hg vs usual care 85.0 mm Hg; P <.01) compared with participants in the usual care group at 6 weeks. Compared with the usual care group, the proportion of participants in the intervention group who had 80% or greater adherence to an antidepressant medication (intervention 71.9% vs usual care 31.3%; P <.01) and to an antihypertensive medication (intervention 78.1% vs usual care 31.3%; P <.001) was greater at 6 weeks.CONCLUSION A pilot, randomized controlled trial integrating depression and hypertension treatment was successful in improving patient outcomes. Integrated interventions may be more feasible and effective in real-world practices, where there are competing demands for limited resources. Ann Fam Med 2008;6:295-301. DOI: 10.1370/afm.843. INTRODUCTIONP rimary care occupies a strategic position in the evaluation and treatment of depression among older adults, 1 and enhancing depression management in primary care appears to be a promising use of health care resources.2 To have an impact on public health, advances in the treatment of depression must be realized in primary care. Although recent studies have shown that a variety of primary care interventions can improve depression outcomes among older adults, 3,4 these interventions are not being widely implemented in practice. Some evidence indicates that addressing medical comorbidity, especially cardiovascular disease (CVD), may be essential in managing depression. [5][6][7] In addition, managing depression in the context of medical comorbidity may be more acceptable to patients than managing depression alone. DEPR ES SION A ND HY PER T ENSION T R E AT MEN Tmanagement of depression with management of medical comorbidity.In this trial, we focused on integrating depression management into care for hypertension. Hypertension affects between 20% to 50% of adults in most countries 9 and is a major risk factor for cardiovascular morbidity and mortality, 10 representing two-thirds of all s...

This exploratory, qualitative study documents ways in which being employed is helpful to victims of intimate partner violence (IPV). The authors conducted in-depth interviews with 21 women employed by a large health care organization in a major U.S. city. Through content analysis, the authors identified six ways in which employment was helpful to participants: by (1) improving their finances, (2) promoting physical safety, (3) increasing self-esteem, (4) improving social connectedness, (5) providing mental respite, and (6) providing motivation or a "purpose in life." Findings suggest that employment can play a critically important, positive role in the lives of IPV victims. The importance of flexible leave-time policies and employer assistance to IPV victims is discussed.

Objective-To examine the patterns of previous and current mental health services use among older adults in the Baltimore Epidemiologic Catchment Area Follow-up. Examination of a recent cohort of older adults is important because patterns of utilization may have changed due to treatment advances, changes in mental health-care services, and greater mental health awareness.Design-A population-based longitudinal survey. Setting-Continuing participants in a study of community-dwelling adults who were living in East Baltimore in 1981.Participants-In all, 1,067 adults for whom complete data were available.Measurements-Separately, and before the mental health assessments were made, participants were asked about use of health services. Cognitive status and physical health were assessed using standardized instruments. Mental disorders were assessed using the Diagnostic Interview Schedule.Results-Compared with adults aged 40-59 years in 2004, adults aged 60 years and older were less likely to report specialty mental health services versus general medical care without a mental health component (adjusted odds ratio = 0.28, 95% confidence interval [0.14-0.56]). Multivariate models controlled for potentially influential characteristics including major depression or depression associated with recent bereavement, anxiety disorders, and past use of mental health services.Conclusion-Adults aged 60 years and older are approximately one third as likely to consult a specialist in mental health compared with adults aged 40-59 years even accounting for other factors associated with differential use of services. Our study strengthens evidence that the primary care remains important for the treatment of psychiatric disorders in the elderly.