OBJECTIVE: Depression is a prevalent high-impact illness with poor outcomes in primary care settings. We performed a systematic review to determine to what extent multifaceted interventions improve depression outcomes in primary care and to define key elements, patients who are likely to benefit and resources required for these interventions. METHOD: We searched Medline, HealthSTAR, CINAHL, PsycINFO and a specialized registry of depression trials from 1966 to February 2006; reviewed bibliographies of pertinent articles; and consulted experts. Searches were limited to the English language. We included 28 randomized controlled trials that: (a) involved primary care patients receiving acute-phase treatment; (b) tested a multicomponent intervention involving a patient-directed component; and (c) reported effects on depression severity. Pairs of investigators independently abstracted information regarding (a) setting and subjects, (b) components of the intervention and (c) outcomes. RESULTS: Twenty of 28 interventions improved depression outcomes over 3-12 months (an 18.4% median absolute increase in patients with 50% improvement in symptoms; range, 8.3-46%). Sustained improvements at 24-57 months were demonstrated in three studies addressing acute-phase and continuation-phase treatments. All interventions involved care management and required additional resources or staff reassignment to implement; interventions were delivered exclusively or predominantly by telephone in 16 studies. The most commonly used intervention features were: patient education and self-management, monitoring of depressive symptoms and treatment adherence, decision support for medication management, a patient registry and mental health supervision of care managers. Other intervention features were highly variable. CONCLUSION: There is strong evidence supporting the short-term benefits of care management for depression; critical elements for successful programs are emerging.
OBJECTIVE:Depression is a prevalent high-impact illness with poor outcomes in primary care settings. We performed a systematic review to determine to what extent multifaceted interventions improve depression outcomes in primary care and to define key elements, patients who are likely to benefit and resources required for these interventions. METHOD: We searched Medline, HealthSTAR, CINAHL, PsycINFO and a specialized registry of depression trials from 1966 to February 2006; reviewed bibliographies of pertinent articles; and consulted experts. Searches were limited to the English language. We included 28 randomized controlled trials that: (a) involved primary care patients receiving acute-phase treatment; (b) tested a multicomponent intervention involving a patient-directed component; and (c) reported effects on depression severity. Pairs of investigators independently abstracted information regarding (a) setting and subjects, (b) components of the intervention and (c) outcomes. RESULTS: Twenty of 28 interventions improved depression outcomes over 3-12 months (an 18.4% median absolute increase in patients with 50% improvement in symptoms; range, 8.3-46%). Sustained improvements at 24-57 months were demonstrated in three studies addressing acute-phase and continuation-phase treatments. All interventions involved care management and required additional resources or staff reassignment to implement; interventions were delivered exclusively or predominantly by telephone in 16 studies. The most commonly used intervention features were: patient education and self-management, monitoring of depressive symptoms and treatment adherence, decision support for medication management, a patient registry and mental health supervision of care managers. Other intervention features were highly variable. CONCLUSION: There is strong evidence supporting the short-term benefits of care management for depression; critical elements for successful programs are emerging.
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: Andrea D Furlan; William H Gnam; Nancy Carnide; Emma Irvin; Benjamin C Amick; Kelly DeRango; Robert McMaster; Kimberley Cullen; Tesha Slack; Sandra Brouwer; Ute Bültmann Journal: J Occup Rehabil Date: 2012-09
Authors: Leif I Solberg; Russell E Glasgow; Jürgen Unützer; Nancy Jaeckels; Gary Oftedahl; Arne Beck; Michael V Maciosek; A Lauren Crain Journal: Med Care Date: 2010-07 Impact factor: 2.983
Authors: Chuan-Fen Liu; Lisa V Rubenstein; JoAnn E Kirchner; John C Fortney; Mark W Perkins; Scott K Ober; Jeffrey M Pyne; Edmund F Chaney Journal: Health Serv Res Date: 2009-02 Impact factor: 3.402