Cost-effectiveness of Improving Primary Care Treatment of Late-Life Depression

Katon, Wayne

doi:10.1001/archpsyc.62.12.1313

Cited by 208 publications

(194 citation statements)

References 42 publications

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“…Raw scores from the depressionspecific measure were linearly interpolated to reflect utilities between 0.51 and 1.0. However, the utilities that Lave et al (1998) and Katon et al (2005) averaged were not all elicited from patients with depression. Utilities derived from patients (vs. providers or nonpatients) are preferred (Hlatk, 1995;Montgomery and Fahey, 2001).…”

Section: Estimating Health Utilitiesmentioning

confidence: 98%

“…Because administering the SG is not always feasible, researchers have relied on previously published utilities. For example, Lave et al (1998) and Katon et al (2005) used the average of six published depression-related utilities scores. Participants considered depressed (via the researchers' depression outcome) were assigned a utility of 0.51 and participants considered not depressed were assigned a utility of 1.…”

Section: Estimating Health Utilitiesmentioning

confidence: 99%

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Estimating health utilities and quality adjusted life years in seasonal affective disorder research

Freed

Rohan

Yates

2007

Journal of Affective Disorders

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Background: Seasonal affective disorder (SAD) episodes will recur annually without effective intervention. Effectiveness of such interventions is traditionally measured with depression-specific tools (e.g., Beck Depression Inventory 2nd Edition; BDI-II). In a climate of potentially scarce resources, generic outcomes, such as Quality Adjusted Life Years (QALYs), are recommended for cost-effectiveness research. For treatments to be deemed cost-effective, they must show effectiveness relative to each other and relative to interventions across other disorders. To date, QALYs have not been used to determine effectiveness of SAD treatments. Given the recurrent nature of SAD, QALYs, which weight quality of life with time, are an ideal SAD treatment outcome. Method: A method to assess QALYs for SAD was developed using pilot clinical trial data. The method estimated health utilities, a measure of quality of life for a QALY, by anchoring pilot BDI-II data from the SAD clinical trial with previously derived health utilities for nonseasonal depression. Results: Relative to no treatment, median QALYs gained ranged from 0.11-0.18 over 1 year, depending on the intervention assessed. Discussion: Any treatment for SAD must compete with spontaneous spring remission, as illness severity attenuates in the spring. Limitations: Health utilities were estimated from the depression literature, and potential side effects from SAD treatments were not included in the estimates. The clinical trial time horizon was limited to 1-year. Conclusions: The proposed method offers researchers a tool to transform SAD efficacy data into a generic outcome for use in costeffectiveness analysis of SAD treatments.

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Section: Estimating Health Utilitiesmentioning

confidence: 98%

Section: Estimating Health Utilitiesmentioning

confidence: 99%

Estimating health utilities and quality adjusted life years in seasonal affective disorder research

Freed

Rohan

Yates

2007

Journal of Affective Disorders

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“…As the U.S. population continues to age, there is a growing need to improve the process and technologies of advance care planning for older adults with chronic disease to ensure that the care they receive is aligned with their personal preferences, priorities, and values (Sherbourne & Stewart, 1991;Bernard, 1994;Doing Qualitative Research: Methods for Primary Care, 1999;Kroenke & Spitzer, 2002;Horsman, Furlong, Feeny, & Torrance, 2003;Bakitas et al, 2004;Patel, Sinuff, & Cook, 2004;Callahan et al, 2005;Katon et al, 2005;Austrom et al, 2006;Callahan et al, 2006;Spitzer, Kroenke, Williams, & Lowe, 2006;S. R. Counsell et al, 2007;Department of Health, 2008;Steven R Counsell, Callahan, Tu, Stump, & Arling, 2009;Glaser & Strauss, 2009;Baughman et al, 2012;Working Group on Health Outcomes for Older Persons with Multiple Chronic Conditions, 2012;Cottingham AH, 2014;Kirolos et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Enhancing the prospects for palliative care at the end of life: A statewide educational demonstration project to improve advance care planning

et al. 2016

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Objectives: Although patients want to participate in discussions and decisions about their end-of-life care, studies show providers frequently fail to invite them to explore advanced care preferences or goals for living. The purpose of this demonstration project was to provide education and coaching to individuals, health providers and organizations across the state of Indiana intended to facilitate these conversations, documenting and honoring individuals' life goals and preferences for care in the final stages of life.Methods: Education and training engaged community members as well as health care providers to: 1) improve participant comfort and facility discussing end-of-life issues; 2) improve knowledge of health care choices, including palliative and hospice care; and 3) prepare all participants to explore and document personal values, life goals and priorities as well as goals of care.Results: Between January 2013 and June 2015, the team educated close to 5,000 participants.Participants' ratings of the quality and perceived usefulness of the events ranged from 4-5 (using 5-point scales; 5 = most effective). Participant comments were overwhelmingly favorable and indicated an intention to put the advance care planning resources, communication skills, knowledge of palliative and hospice care, and personal renewal techniques into practice. Significance of Results:Participant motivation to foster advance care planning, discussions of palliative care, and end-of-life conversations was facilitated by the reframing of these conversations as identifying goals of care and priorities for living well in an important stage of life. Successful strategies included helping providers and patients to adopt a broader meaning for ''sustaining hope" (not for cure, but for engaging in highly valued activities), developing provider communication skills and comfort in initiating potentially difficult discussions, engaging a new community health workforce who developed trusting relationship with patients in home-based services and fostering self-awareness and self-care among palliative care providers.Key words/phrases: Skill development for end-of-life conversations; providers' self-awareness and selfcare surrounding end-of-life care; community health workers' role in end-of-life conversations 3

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“…Patient populations often include seniors with dementia [14], depression [21][22][23][24][25], arthritis [26], as well as minority groups [22], veterans [13], house-bound [11,12], complex [27], palliative [18], and low-income seniors [28]. Evaluations of interdisciplinary teams have mainly focused on patient and their informal caregivers [11,19,29]. Enhanced care processes of reduced wait times to access specialized services, increased pneumonia vaccination rates, and improved medication prescribing were reported (19,20,30).…”

Section: Introductionmentioning

confidence: 99%

Physician and Nurse Perspectives of an Interprofessional and Integrated Primary Care-Based Program for Seniors

Moore¹,

Nair

Patterson

et al. 2013

JRIPE

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Background: In Canada, primary care practitioners provide the majority of care for elderly patients. Increasing volume and complexity of care compounded by a shortage of specialized geriatric services has lead to problems of fragmented, inefficient, and often ineffective service for this population. Integrated models that bridge primary and secondary care have emerged as a major theme in health reform to address such challenges for care of the elderly. Although primary care practitioners are important stakeholders necessary for successful uptake and sustainability of such integrated models, this perspective has been largely unexplored.

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Cost-effectiveness of Improving Primary Care Treatment of Late-Life Depression

Abstract: The IMPACT intervention is a high-value investment for older adults; it is associated with high clinical benefits at a low increment in health care costs.

Cited by 208 publications

References 42 publications

Estimating health utilities and quality adjusted life years in seasonal affective disorder research

Estimating health utilities and quality adjusted life years in seasonal affective disorder research

Enhancing the prospects for palliative care at the end of life: A statewide educational demonstration project to improve advance care planning

Physician and Nurse Perspectives of an Interprofessional and Integrated Primary Care-Based Program for Seniors

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