Six-Month Outcomes for Collaborative Care Management of Depression Among Smoking and Nonsmoking Patients

Abstract

Background:Collaborative care management (CCM) is an evidence-based model that contributes to better outcomes for depression treatment in the primary care setting. Tobacco use increases overall economic costs, morbidity, and mortality and has been shown to impact behavioral health outcomes. Our study aims to observe clinical outcomes for depression treatment for patients with comorbid tobacco use and depression within the CCM model.Methods:A retrospective chart review study of 2826 adult patients with depression enrolled in CCM was performed to determine the association between regular tobacco use and depression outcomes. Baseline intake data consisting of clinical and demographic variables along with 6-month follow-up of Patient Health Questionnaire-9 (PHQ-9) scores for smokers (n = 727, 25.7%) and nonsmokers (n = 2099, 74.3%) were obtained. Depression remission was defined as a PHQ-9 score <5 and persistent depressive symptoms (PDS) as a PHQ-9 score ≥10 at 6 months.Results:Using an intention-to-treat analysis, the multivariate modeling demonstrated that smokers, at 6 months, had an increased adjusted odds ratio (AOR) for PDS: 1.624 (95% CI: 1.353-1.949). Furthermore, smokers had a lower AOR of depression remission: 0.603 (95% CI: 0.492-0.739). Patient adherence to treatment was also lower in smokers with an AOR of 0.666 (95% CI: 0.553-0.802).Conclusions:Smokers enrolled in CCM were associated with reduced treatment adherence and worse outcomes for depression treatment at 6 months compared to nonsmokers, even when baseline clinical and demographic variables were controlled. Thus, new tailored practices may be warranted within the CCM model to treat comorbid depression and tobacco use disorders.

Impact of rural address and distance from clinic on depression outcomes within a primary care medical home practice

“…As expected based on prior work, multivariate analysis of remission revealed that most DOC-6 components (age, recurrent depression, initial PHQ-9 score, GAD-7 score, and MDQ), smoking status, and enrollment in CCM were all significantly associated with adjusted remission odds as shown in Fig. 3 [14, 17, 27, 29, 30]. Rural patients had improved adjusted odds of remission (AOR = 2.8, 95%CI 1.4–5.9) compared to urban area patients while urban cluster patients were not different.…”

“…Distance from the patient’s address to their primary care clinic was calculated in kilometers using the Haversine formula [26]. The other independent variables were included to adjust depression outcomes as they are known to be significant [17, 27].…”

Depression Outcomes in Smokers and Nonsmokers: Comparison of Collaborative Care Management Versus Usual Care

“…44 Similar to our previously published results within CCM, smoking was associated with worse depression outcomes than nonsmokers. 41 Contrary to our hypothesis, we did not observe a difference in depression outcomes between smokers and nonsmokers treated with UC. With less collaborative care and lack of consistent psychotherapy resources, UC has lower odds of remission than CCM irrespective of smoking status.…”

“…44 Similar to our previously published results within CCM, smoking was associated with worse depression outcomes than nonsmokers. 41…”

“…35,[37][38][39][40] Recently, we reviewed the electronic records of 2826 depressed patients enrolled in CCM and found that current smokers had an associated decreased treatment adherence and worse clinical outcomes at 6 months compared with non-smokers. 41 Therefore, we sought to evaluate whether a current smoking history had a negative impact on depression treatment of adult primary care patients in the context of treatment with UC versus treatment with CCM. Given our recent data within CCM, we hypothesized that current smoking would also negatively affect 6-month depression outcome in patients treated with UC.…”