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Long-term effects of a collaborative care intervention in persistently depressed primary care patients

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Abstract

OBJECTIVE: A previous study described the effect of a collaborative care intervention on improving adherence to antidepressant medications and depressive and functional outcomes of patients with persistent depressive symptoms 8 weeks after the primary care physician initiated treatment. This paper examined the 28-month effect of this intervention on adherence, depressive symptoms, functioning, and health care costs.

DESIGN: Randomized trial of stepped collaborative care intervention versus usual care.

SETTING: HMO in Seattle, Wash.

PATIENTS: Patients with major depression were stratified into severe and moderate depression groups prior to randomization.

INTERVENTIONS: A multifaceted intervention targeting patient, physician, and process of care, using collaborative management by a psychiatrist and a primary care physician.

MEASURES AND MAIN RESULTS: The collaborative care intervention was associated with continued improvement in depressive symptoms at 28 months in patients in the moderate-severity group (F1,87=8.65; P=.004), but not in patients in the high-severity group (F1,51=0.02; P=.88) Improvements in the intervention group in antidepressant adherence were found to occur for the first 6 months (χ2(1)=8.23; P<.01) and second 6-month period (χ2(1)=5.98; P<.05) after randomization in the high-severity group and for 6 months after randomization in the moderate-severity group(χ2(1)=6.10; P<.05). There were no significant differences in total ambulatory costs between intervention and control patients over the 28-month period (F1,180=0.77; P=.40).

CONCLUSIONS: A collaborative care intervention was associated with sustained improvement in depressive outcomes without additional health care costs in approximately two thirds of primary care patients with persistent depressive symptoms.

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Authors and Affiliations

  1. the Center for Health Studies, Group Health Cooperative, Seattle, Wash.

    Michael Von Korff ScD, Elizabeth Lin MD, MPH, Greg Simon MD, Terry Bush PhD & Evette Ludman PhD

  2. Department of Psychiatry and Behavioral Sciences, University of Washington Medical School, Box 356560, 98195, Seattle, WA

    Wayne Katon MD, Joan Russo PhD & Edward Walker MD

Authors
  1. Wayne Katon MD
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  2. Joan Russo PhD
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  3. Michael Von Korff ScD
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  4. Elizabeth Lin MD, MPH
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  5. Greg Simon MD
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  6. Terry Bush PhD
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  7. Evette Ludman PhD
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  8. Edward Walker MD
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Corresponding author

Correspondence to Wayne Katon MD.

Additional information

This work was supported by grants #MH-4-1739 and #MH 016473 from the National Institute of Mental Health Services Division in Bethesda, Md (Dr. Katon).

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Katon, W., Russo, J., Von Korff, M. et al. Long-term effects of a collaborative care intervention in persistently depressed primary care patients. J GEN INTERN MED 17, 741–748 (2002). https://doi.org/10.1046/j.1525-1497.2002.11051.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2002.11051.x

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