Randomised trial of monitoring, feedback, and management of care by telephone to improve treatment of depression in primary care

Simon, Gregory E.; VonKorff, Michael; Rutter, Carolyn M.; Wagner, Edward H.

doi:10.1136/bmj.320.7234.550

Cited by 472 publications

(384 citation statements)

References 28 publications

Supporting

Mentioning

363

Contrasting

Unclassified

Order By: Relevance

“…[15][16][17] Collaborative models of chronic mental illness care that coordinate between primary care and care managers (CMs) are a proven approach to improving depression care in primary care settings. 8,[18][19][20] There is growing evidence that such collaborative care interventions may be adapted and implemented to address PTSD as well. But PTSD treatment is less routine in primary care and its care is more challenging because of barriers at the patient, physician and practice levels.…”

Section: Introductionmentioning

confidence: 99%

Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: a Randomized Controlled Trial

et al. 2016

View full text Add to dashboard Cite

BACKGROUND:The effectiveness of collaborative care of mental health problems is clear for depression and growing but mixed for anxiety disorders, including posttraumatic stress disorder (PTSD). We know little about whether collaborative care can be effective in settings that serve low-income patients such as Federally Qualified Health Centers (FQHCs). OBJECTIVE: We compared the effectiveness of minimally enhanced usual care (MEU) versus collaborative care for PTSD with a care manager (PCM). DESIGN: This was a multi-site patient randomized controlled trial of PTSD care improvement over 1 year. PARTICIPANTS: We recruited and enrolled 404 patients in six FQHCs from June 2010 to October 2012. Patients were eligible if they had a primary care appointment, no obvious physical or cognitive obstacles to participation, were age 18-65 years, planned to continue care at the study location for 1 year, and met criteria for a past month diagnosis of PTSD. MAIN MEASURES: The main outcomes were PTSD diagnosis and symptom severity (range, 0-136) based on the Clinician-Administered PTSD Scale (CAPS). Secondary outcomes were medication and counseling for mental health problems, and health-related quality of life assessed at baseline, 6 months, and 12 months. KEY RESULTS: Patients in both conditions improved similarly over the 1-year evaluation period. At 12 months, PTSD diagnoses had an absolute decrease of 56.7 % for PCM patients and 60.6 % for MEU patients. PTSD symptoms decreased by 26.8 and 24.2 points, respectively. MEU and PCM patients also did not differ in process of care outcomes or health-related quality of life. Patients who actually engaged in care management had mental health care visits that were 14 % higher (p < 0.01) and mental health medication prescription rates that were 15.2 % higher (p < 0.01) than patients with no engagement. CONCLUSIONS:A minimally enhanced usual care intervention was similarly effective as collaborative care for patients in FQHCs.

show abstract

Section: Introductionmentioning

confidence: 99%

Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: a Randomized Controlled Trial

et al. 2016

View full text Add to dashboard Cite

show abstract

“…chronic conditions including depression Hunkeler et al, 2000;Katzelnick et al, 2000;Rost, Nutting, Smith, Werner, & Duan, 2001;Simon, Von Korff, Rutter, & Wagner, 2000;Unutzer et al, 2002;Wells et al, 2000), anxiety (Roy-Byrne, Katon, Cowley, & Russo, 2001), alcohol use disorders (Oslin et al, 2003), and physical health conditions (Aubert et al, 1998;Delaronde, 2002;Rich et al, 1995), at a lower total cost of care (Rich et al, 1995), particularly among the more severely ill (Wasson et al, 1992).…”

mentioning

confidence: 99%

Implementation of Guideline-Based Care for Depression in Primary Care

Rollman

Korsen

Schulberg

2005

Adm Policy Ment Health

View full text Add to dashboard Cite

Evidence-based clinical practice guidelines for treating depression in primary care settings were developed, in part, to ensure that health services are provided in a consistent, highquality, and cost-effective manner. Yet for a variety of reasons, guideline-based primary care for depression remains the exception rather than the rule. This work provides a brief review of effective strategies used to customize and then deliver evidence-based treatment for depression in primary care settings; describes two representative case studies that illustrate locally customized collaborative care strategies for treatment delivery; and concludes with principles and implications for policy and practice based on our practical experiences.

show abstract

“…The lower range of estimated costs would result if two telephone-based visits were included in each of three incremental visits. Telephone visits are less expensive, and there is substantial research indicating the effectiveness of telephone-based care in improving outcomes for patients newly starting antidepressants (29,31–33). Thus telephone visits may also play a role in efforts to reduce suicide.…”

Section: Discussionmentioning

confidence: 99%

“…Antidepressant costs may increase if closer monitoring results in more medication adjustments and increased adherence. To estimate potential incremental pharmacy costs associated with closer monitoring, we multiplied the mean cost of antidepressants in the first 12-week high-risk periods during FY 2004 ($121.42) by the observed increases in antidepressant adherence (15%–65%) reported during collaborative care interventions for depression (29–31). …”

Section: Methodsmentioning

confidence: 99%

Service Implications of Providing Intensive Monitoring During High-Risk Periods for Suicide Among VA Patients With Depression

Valenstein¹,

Eisenberg²,

McCarthy³

et al. 2009

Psychiatric Services

View full text Add to dashboard Cite

Objectives Department of Veterans Affairs (VA) patients in depression treatment have high suicide rates after psychiatric hospitalization, antidepressant starts, and dosage changes. Policy makers have recommended closer monitoring during these periods to reduce suicide. This study assessed the frequency of high-risk periods in clinical settings, the levels of monitoring provided during these periods, and the estimated costs of providing monitoring consistent with the most stringent Food and Drug Administration recommendation for treatment periods after antidepressant change (seven visits in the first 12 weeks). Methods Monitoring visits were identified in the 12-week period after antidepressant starts and dosage changes and after discharge from psychiatric hospitalization for 100,000 randomly selected VA patients in depression treatment between April 1, 1999, and September 30, 2004. Incremental costs of providing intensive monitoring were estimated by using VA Health Economics Resource Center average cost data. Results Patients averaged less than one high-risk period each year. They completed an average of 2.4 monitoring visits during the 12-week period after antidepressant treatment events and 4.9 visits after psychiatric hospitalization. Providing intensive monitoring would cost an additional $408–$537 for each high-risk period after antidepressant treatment events and $313–$341 for each high-risk period after psychiatric hospitalization. During fiscal year 2004 providing intensive monitoring during all high-risk periods would have cost an additional $183–$270 million. Providing intensive monitoring only after psychiatric hospitalizations would have cost an additional $15–$17 million. Conclusions Providing intensive monitoring for VA patients in depression treatment during all high-risk periods for suicide would require substantial services reorganization and incremental expenditures. Modest expenditures would support intensive monitoring during the highest-risk period that follows psychiatric hospitalization.

show abstract

Randomised trial of monitoring, feedback, and management of care by telephone to improve treatment of depression in primary care

Abstract: Objective To test the effectiveness of two programmes to improve the treatment of acute depression in primary care. Design Randomised trial.

Cited by 472 publications

References 28 publications

Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: a Randomized Controlled Trial

Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: a Randomized Controlled Trial

Implementation of Guideline-Based Care for Depression in Primary Care

Service Implications of Providing Intensive Monitoring During High-Risk Periods for Suicide Among VA Patients With Depression

Contact Info

Product

Resources

About