Telephone-Delivered Collaborative Care for Treating Post-CABG Depression

Abstract

ORONARY ARTERY BYPASS graft (CABG) surgery is one of the most common and costly medical procedures performed in the United States. 1 Its main indications are the relief of angina and improvement in quality of life. 2 Yet as many as half of post-CABG patients report depressive symptoms in the perioperative period, 3 are more likely to experience a decreased healthrelated quality of life (HRQL) and functional status, 4 continued chest pains, 5,6 and inreased rates of rehospitalization and death following CABG surgery independent of cardiac status, medical comorbidity, or the extent of surgery. [7][8][9][10][11] Although the mechanism whereby depression affects post-CABG outcomes remains unknown, 12 widely generalizable strategies to detect and effectively treat post-CABG depression are of great interest. Several treatment trials for depression have been conducted in cardiac populations, but most achieved less than anticipated benefits with regard to reducing mood symptoms [13][14][15][16][17][18][19] or cardiovascular morbidity. [13][14][15][16]19,20 Moreover, none used the proven effective collabo-rative care approach 21 recently recommended by a National Institutes of Health expert consensus panel. 22 Unlike earlier interventions that used a single antidepressant, 13,15,17,18 counseling modality, 20 or antidepressant in combination with counseling for treating cardiacpatientswithdepression, 14,19 collabo-rative care emphasizes a flexible realworld treatment package that involves active follow-up by a nonphysician care manager who adheres to evidence-based Author Affiliations are listed at the end of this article.

Provider Patient-Sharing Networks and Multiple-Provider Prescribing of Benzodiazepines

“…29,30 One strategy that has been proven effective in a number of randomized controlled trials is a collaborative care plan that implements active follow-up by a non-physician care manager or nurse, who proactively monitors patients' progress and facilitates care coordination with their physicians. [30][31][32] While the initial costs of setting up such an intervention may be high, in the long term, they are offset by the reduced need for medical care. 33 Our findings differ from existing studies in a number of ways.…”

Community-Partnered Evaluation of Depression Services for Clients of Community-Based Agencies in Under-Resourced Communities in Los Angeles

“…Our response rates for clients and programs were acceptable (78 to over 90 %), but low to moderate (50 %) for agencies relative to the field. Many studies of quality improvement in specific sites or applying CBPR to health rely on convenience samples, 7,38,[55][56][57][58][59][60][61] and use integrated systems or households or settings in government districts. 39,49,[62][63][64][65][66] The study findings are based on client self-report and may not accurately reflect actual service use due to problems such as client recall.…”

Anxiety and Depression in Cardiovascular Surgery

“…Rollman et al had tested the effectiveness of an 8 month, biweekly, nurse-led telephone-delivered collaborative care for post-CABG depression vs. usual physician care in a randomized controlled trial [43]. A nurse telephoned to intervention patients and provided basic psychoeducation about depression and its impact on cardiac disease using a workbook.…”