Collaborative care management of late-life depression in the primary care setting

A randomized controlled trial

Jürgen Unützer, Wayne Katon, Christopher Callahan, John W. Williams, Enid Hunkeler, Linda Harpole, Marc Hoffing, Richard D. Della Penna, Polly Hitchcock Noël, Elizabeth H B Lin, Patricia A. Areán, Mark T. Hegel, Lingqi Tang, Thomas R. Belin, Sabine Oishi, Christopher Langston

Research output: Contribution to journalArticle

1622 Citations (Scopus)

Abstract

Context: Few depressed older adults receive effective treatment in primary care settings. Objective: To determine the effectiveness of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) collaborative care management program for late-life depression. Design: Randomized controlled trial with recruitment from July 1999 to August 2001. Setting: Eighteen primary care clinics from 8 health care organizations in 5 states. Participants: A total of 1801 patients aged 60 years or older with major depression (17%), dysthymic disorder (30%), or both (53%). Intervention: Patients were randomly assigned to the IMPACT intervention (n=906) or to usual care (n=895). Intervention patients had access for up to 12 months to a depression care manager who was supervised by a psychiatrist and a primary care expert and who offered education, care management, and support of antidepressant management by the patient's primary care physician or a brief psychotherapy for depresssion, Problem Solving Treatment in Primary Care. Main Outcome Measures: Assessments at baseline and at 3, 6, and 12 months for depression, depression treatments, satisfaction with care, functional impairment, and quality of life. Results: At 12 months, 45% of intervention patients had a 50% or greater reduction in depressive symptoms from baseline compared with 19% of usual care participants (odds ratio [OR], 3.45; 95% confidence interval [CI], 2.71-4.38; P<.001). Intervention patients also experienced greater rates of depression treatment (OR, 2.98; 95% CI, 2.34-3.79; P<.001), more satisfaction with depression care (OR, 3.38; 95% CI, 2.66-4.30; P<.001), lower depression severity (range, 0-4; between-group difference, -0.4; 95% CI, -0.46 to -0.33; P<.001), less functional impairment (range, 0-10; between-group difference, -0.91; 95% CI, -1.19 to -0.64; P<.001), and greater quality of life (range, 0-10; between-group difference, 0.56; 95% CI, 0.32-0.79; P<.001) than participants assigned to the usual care group. Conclusion: The IMPACT collaborative care model appears to be feasible and significantly more effective than usual care for depression in a wide range of primary care practices.

Original languageEnglish
Pages (from-to)2836-2845
Number of pages10
JournalJournal of the American Medical Association
Volume288
Issue number22
DOIs
StatePublished - Dec 11 2002

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Primary Health Care
Randomized Controlled Trials
Depression
Confidence Intervals
Odds Ratio
Therapeutics
Dysthymic Disorder
Quality of Life
Outcome Assessment (Health Care)
Brief Psychotherapy
Primary Care Physicians
Antidepressive Agents
Psychiatry
Patient Care
Organizations
Delivery of Health Care
Education

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Collaborative care management of late-life depression in the primary care setting : A randomized controlled trial. / Unützer, Jürgen; Katon, Wayne; Callahan, Christopher; Williams, John W.; Hunkeler, Enid; Harpole, Linda; Hoffing, Marc; Della Penna, Richard D.; Noël, Polly Hitchcock; Lin, Elizabeth H B; Areán, Patricia A.; Hegel, Mark T.; Tang, Lingqi; Belin, Thomas R.; Oishi, Sabine; Langston, Christopher.

In: Journal of the American Medical Association, Vol. 288, No. 22, 11.12.2002, p. 2836-2845.

Research output: Contribution to journalArticle

Unützer, J, Katon, W, Callahan, C, Williams, JW, Hunkeler, E, Harpole, L, Hoffing, M, Della Penna, RD, Noël, PH, Lin, EHB, Areán, PA, Hegel, MT, Tang, L, Belin, TR, Oishi, S & Langston, C 2002, 'Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial', Journal of the American Medical Association, vol. 288, no. 22, pp. 2836-2845. https://doi.org/10.1001/jama.288.22.2836
Unützer, Jürgen ; Katon, Wayne ; Callahan, Christopher ; Williams, John W. ; Hunkeler, Enid ; Harpole, Linda ; Hoffing, Marc ; Della Penna, Richard D. ; Noël, Polly Hitchcock ; Lin, Elizabeth H B ; Areán, Patricia A. ; Hegel, Mark T. ; Tang, Lingqi ; Belin, Thomas R. ; Oishi, Sabine ; Langston, Christopher. / Collaborative care management of late-life depression in the primary care setting : A randomized controlled trial. In: Journal of the American Medical Association. 2002 ; Vol. 288, No. 22. pp. 2836-2845.
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abstract = "Context: Few depressed older adults receive effective treatment in primary care settings. Objective: To determine the effectiveness of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) collaborative care management program for late-life depression. Design: Randomized controlled trial with recruitment from July 1999 to August 2001. Setting: Eighteen primary care clinics from 8 health care organizations in 5 states. Participants: A total of 1801 patients aged 60 years or older with major depression (17{\%}), dysthymic disorder (30{\%}), or both (53{\%}). Intervention: Patients were randomly assigned to the IMPACT intervention (n=906) or to usual care (n=895). Intervention patients had access for up to 12 months to a depression care manager who was supervised by a psychiatrist and a primary care expert and who offered education, care management, and support of antidepressant management by the patient's primary care physician or a brief psychotherapy for depresssion, Problem Solving Treatment in Primary Care. Main Outcome Measures: Assessments at baseline and at 3, 6, and 12 months for depression, depression treatments, satisfaction with care, functional impairment, and quality of life. Results: At 12 months, 45{\%} of intervention patients had a 50{\%} or greater reduction in depressive symptoms from baseline compared with 19{\%} of usual care participants (odds ratio [OR], 3.45; 95{\%} confidence interval [CI], 2.71-4.38; P<.001). Intervention patients also experienced greater rates of depression treatment (OR, 2.98; 95{\%} CI, 2.34-3.79; P<.001), more satisfaction with depression care (OR, 3.38; 95{\%} CI, 2.66-4.30; P<.001), lower depression severity (range, 0-4; between-group difference, -0.4; 95{\%} CI, -0.46 to -0.33; P<.001), less functional impairment (range, 0-10; between-group difference, -0.91; 95{\%} CI, -1.19 to -0.64; P<.001), and greater quality of life (range, 0-10; between-group difference, 0.56; 95{\%} CI, 0.32-0.79; P<.001) than participants assigned to the usual care group. Conclusion: The IMPACT collaborative care model appears to be feasible and significantly more effective than usual care for depression in a wide range of primary care practices.",
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T1 - Collaborative care management of late-life depression in the primary care setting

T2 - A randomized controlled trial

AU - Unützer, Jürgen

AU - Katon, Wayne

AU - Callahan, Christopher

AU - Williams, John W.

AU - Hunkeler, Enid

AU - Harpole, Linda

AU - Hoffing, Marc

AU - Della Penna, Richard D.

AU - Noël, Polly Hitchcock

AU - Lin, Elizabeth H B

AU - Areán, Patricia A.

AU - Hegel, Mark T.

AU - Tang, Lingqi

AU - Belin, Thomas R.

AU - Oishi, Sabine

AU - Langston, Christopher

PY - 2002/12/11

Y1 - 2002/12/11

N2 - Context: Few depressed older adults receive effective treatment in primary care settings. Objective: To determine the effectiveness of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) collaborative care management program for late-life depression. Design: Randomized controlled trial with recruitment from July 1999 to August 2001. Setting: Eighteen primary care clinics from 8 health care organizations in 5 states. Participants: A total of 1801 patients aged 60 years or older with major depression (17%), dysthymic disorder (30%), or both (53%). Intervention: Patients were randomly assigned to the IMPACT intervention (n=906) or to usual care (n=895). Intervention patients had access for up to 12 months to a depression care manager who was supervised by a psychiatrist and a primary care expert and who offered education, care management, and support of antidepressant management by the patient's primary care physician or a brief psychotherapy for depresssion, Problem Solving Treatment in Primary Care. Main Outcome Measures: Assessments at baseline and at 3, 6, and 12 months for depression, depression treatments, satisfaction with care, functional impairment, and quality of life. Results: At 12 months, 45% of intervention patients had a 50% or greater reduction in depressive symptoms from baseline compared with 19% of usual care participants (odds ratio [OR], 3.45; 95% confidence interval [CI], 2.71-4.38; P<.001). Intervention patients also experienced greater rates of depression treatment (OR, 2.98; 95% CI, 2.34-3.79; P<.001), more satisfaction with depression care (OR, 3.38; 95% CI, 2.66-4.30; P<.001), lower depression severity (range, 0-4; between-group difference, -0.4; 95% CI, -0.46 to -0.33; P<.001), less functional impairment (range, 0-10; between-group difference, -0.91; 95% CI, -1.19 to -0.64; P<.001), and greater quality of life (range, 0-10; between-group difference, 0.56; 95% CI, 0.32-0.79; P<.001) than participants assigned to the usual care group. Conclusion: The IMPACT collaborative care model appears to be feasible and significantly more effective than usual care for depression in a wide range of primary care practices.

AB - Context: Few depressed older adults receive effective treatment in primary care settings. Objective: To determine the effectiveness of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) collaborative care management program for late-life depression. Design: Randomized controlled trial with recruitment from July 1999 to August 2001. Setting: Eighteen primary care clinics from 8 health care organizations in 5 states. Participants: A total of 1801 patients aged 60 years or older with major depression (17%), dysthymic disorder (30%), or both (53%). Intervention: Patients were randomly assigned to the IMPACT intervention (n=906) or to usual care (n=895). Intervention patients had access for up to 12 months to a depression care manager who was supervised by a psychiatrist and a primary care expert and who offered education, care management, and support of antidepressant management by the patient's primary care physician or a brief psychotherapy for depresssion, Problem Solving Treatment in Primary Care. Main Outcome Measures: Assessments at baseline and at 3, 6, and 12 months for depression, depression treatments, satisfaction with care, functional impairment, and quality of life. Results: At 12 months, 45% of intervention patients had a 50% or greater reduction in depressive symptoms from baseline compared with 19% of usual care participants (odds ratio [OR], 3.45; 95% confidence interval [CI], 2.71-4.38; P<.001). Intervention patients also experienced greater rates of depression treatment (OR, 2.98; 95% CI, 2.34-3.79; P<.001), more satisfaction with depression care (OR, 3.38; 95% CI, 2.66-4.30; P<.001), lower depression severity (range, 0-4; between-group difference, -0.4; 95% CI, -0.46 to -0.33; P<.001), less functional impairment (range, 0-10; between-group difference, -0.91; 95% CI, -1.19 to -0.64; P<.001), and greater quality of life (range, 0-10; between-group difference, 0.56; 95% CI, 0.32-0.79; P<.001) than participants assigned to the usual care group. Conclusion: The IMPACT collaborative care model appears to be feasible and significantly more effective than usual care for depression in a wide range of primary care practices.

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