PURPOSE:Depression care management for primary care patients results in sustained improvement in clinical outcomes with diminishing costs over time. Clinical benefits, however, are concentrated primarily in patients who report to their primary care clinicians psychological rather than exclusively physical symptoms. This study proposes to determine whether the intervention affects outpatient costs differentially when comparing patients who have psychological with patients who have physical complaints. METHODS: We undertook a group-randomized controlled trial (RCT) of depression comparing intervention with usual care in 12 primary care practices. Intervention practices encouraged depressed patients to engage in active treatment, using nurses to provide regularly scheduled care management for 24 months. The study sample included 200 adults beginning a new depression treatment episode where patient presentation style could be identified. Outpatient costs were defined as intervention plus outpatient treatment costs for the 2 years. Cost-offset analysis used general linear mixed models, 2-part models, and bootstrapping to test hypotheses regarding a differential intervention effect by patients' style, and to obtain 95% confidence intervals for costs. RESULTS: Intervention effects on outpatient costs over time differed by patient style (P <.05), resulting in a $980 cost decrease for depressed patients who complain of psychological symptoms and a 1,378 dollars cost increase for depressed patients who complain of physical symptoms only. CONCLUSIONS:Depression intervention for a 2-year period produced observable clinical benefit with decreased outpatient costs for depressed patients who complain of psychological symptoms. It produced limited clinical benefit with increased costs, however, for depressed patients who complain exclusively of physical symptoms, suggesting the need for developing new intervention approaches for this group.
RCT Entities:
PURPOSE:Depression care management for primary care patients results in sustained improvement in clinical outcomes with diminishing costs over time. Clinical benefits, however, are concentrated primarily in patients who report to their primary care clinicians psychological rather than exclusively physical symptoms. This study proposes to determine whether the intervention affects outpatient costs differentially when comparing patients who have psychological with patients who have physical complaints. METHODS: We undertook a group-randomized controlled trial (RCT) of depression comparing intervention with usual care in 12 primary care practices. Intervention practices encouraged depressedpatients to engage in active treatment, using nurses to provide regularly scheduled care management for 24 months. The study sample included 200 adults beginning a new depression treatment episode where patient presentation style could be identified. Outpatient costs were defined as intervention plus outpatient treatment costs for the 2 years. Cost-offset analysis used general linear mixed models, 2-part models, and bootstrapping to test hypotheses regarding a differential intervention effect by patients' style, and to obtain 95% confidence intervals for costs. RESULTS: Intervention effects on outpatient costs over time differed by patient style (P <.05), resulting in a $980 cost decrease for depressedpatients who complain of psychological symptoms and a 1,378 dollars cost increase for depressedpatients who complain of physical symptoms only. CONCLUSIONS:Depression intervention for a 2-year period produced observable clinical benefit with decreased outpatient costs for depressedpatients who complain of psychological symptoms. It produced limited clinical benefit with increased costs, however, for depressedpatients who complain exclusively of physical symptoms, suggesting the need for developing new intervention approaches for this group.
Authors: Jeffrey M Pyne; Kathryn M Rost; Farah Farahati; Shanti P Tripathi; Jeffrey Smith; D Keith Williams; John Fortney; James C Coyne Journal: Psychol Med Date: 2005-06 Impact factor: 7.723
Authors: C D Sherbourne; K B Wells; N Duan; J Miranda; J Unützer; L Jaycox; M Schoenbaum; L S Meredith; L V Rubenstein Journal: Arch Gen Psychiatry Date: 2001-07
Authors: Robin R Whitebird; Leif I Solberg; Nancy A Jaeckels; Pamela B Pietruszewski; Senka Hadzic; Jürgen Unützer; Kris A Ohnsorg; Rebecca C Rossom; Arne Beck; Kenneth E Joslyn; Lisa V Rubenstein Journal: Am J Manag Care Date: 2014-09 Impact factor: 2.229
Authors: David W Morris; Nitin Budhwar; Mustafa Husain; Stephen R Wisniewski; Benji T Kurian; James F Luther; Kevin Kerber; A John Rush; Madhukar H Trivedi Journal: Ann Fam Med Date: 2012 Jan-Feb Impact factor: 5.166
Authors: L Miriam Dickinson; W Perry Dickinson; Kathryn Rost; Frank DeGruy; Caroline Emsermann; Desireé Froshaug; Paul A Nutting; Lisa Meredith Journal: J Gen Intern Med Date: 2008-08-05 Impact factor: 5.128
Authors: Dominic Pilon; Holly Szukis; Kruti Joshi; David Singer; John J Sheehan; Jennifer W Wu; Patrick Lefebvre; Paul Greenberg Journal: Pharmacoecon Open Date: 2020-03