TY - JOUR
KW - Antidepressive Agents/therapeutic use
KW - Case Management
KW - Comorbidity
KW - Delivery of Health Care/methods
KW - Depressive Disorder/diagnosis/epidemiology/therapy
KW - Diabetes Mellitus/blood/diagnosis/epidemiology
KW - Female
KW - Health Maintenance Organizations
KW - Hemoglobin A, Glycosylated/analysis
KW - Humans
KW - Male
KW - Middle Aged
KW - Patient Care Team
KW - Patient Satisfaction
KW - Personality Inventory/statistics & numerical data
KW - Psychiatric Status Rating Scales
KW - Psychotherapy/methods
KW - Quality of Health Care/standards
KW - Questionnaires
KW - Severity of Illness Index
KW - Treatment Outcome
AU - W. J. Katon
AU - M. Von Korff
AU - E. H. Lin
AU - G. Simon
AU - E. Ludman
AU - J. Russo
AU - P. Ciechanowski
AU - E. Walker
AU - T. Bush
A1 - 
AB - BACKGROUND: There is a high prevalence of depression in patients with diabetes mellitus. Depression has been shown to be associated with poor self-management (adherence to diet, exercise, checking blood glucose levels) and high hemoglobin A1c (HbA1c) levels in patients with diabetes. OBJECTIVE: To determine whether enhancing quality of care for depression improves both depression and diabetes outcomes in patients with depression and diabetes. DESIGN: Randomized controlled trial with recruitment from March 1, 2001, to May 31, 2002. SETTING: Nine primary care clinics from a large health maintenance organization. PARTICIPANTS: A total of 329 patients with diabetes mellitus and comorbid major depression and/or dysthymia. Intervention Patients were randomly assigned to the Pathways case management intervention (n = 164) or usual care (n = 165). The intervention provided enhanced education and support of antidepressant medication treatment prescribed by the primary care physician or problem-solving therapy delivered in primary care. MAIN OUTCOME MEASURES: Independent blinded assessments at baseline and 3, 6, and 12 months of depression (Hopkins Symptom Checklist 90), global improvement, and satisfaction with care. Automated clinical data were used to evaluate adherence to antidepressant regimens, percentage receiving specialty mental health visits, and HbA1c levels. RESULTS: When compared with usual care patients, intervention patients showed greater improvement in adequacy of dosage of antidepressant medication treatment in the first 6-month period (odds ratio [OR], 4.15; 95% confidence interval [CI], 2.28-7.55) and the second 6-month period (OR, 2.90; 95% CI, 1.69-4.98), less depression severity over time (z = 2.84, P = .004), a higher rating of patient-rated global improvement at 6 months (intervention 69.4% vs usual care 39.3%; OR, 3.50; 95% CI, 2.16-5.68) and 12 months (intervention 71.9% vs usual care 42.3%; OR, 3.50; 95% CI, 2.14-5.72), and higher satisfaction with care at 6 months (OR, 2.01; 95% CI, 1.18-3.43) and 12 months (OR, 2.88; 95% CI, 1.67-4.97). Although depressive outcomes were improved, no differences in HbA1c outcomes were observed. CONCLUSION: The Pathways collaborative care model improved depression care and outcomes in patients with comorbid major depression and/or dysthymia and diabetes mellitus, but improved depression care alone did not result in improved glycemic control.
BT - Archives of General Psychiatry
C5 - HIT & Telehealth
CP - 10
CY - United States
DO - 10.1001/archpsyc.61.10.1042
IS - 10
JF - Archives of General Psychiatry
N2 - BACKGROUND: There is a high prevalence of depression in patients with diabetes mellitus. Depression has been shown to be associated with poor self-management (adherence to diet, exercise, checking blood glucose levels) and high hemoglobin A1c (HbA1c) levels in patients with diabetes. OBJECTIVE: To determine whether enhancing quality of care for depression improves both depression and diabetes outcomes in patients with depression and diabetes. DESIGN: Randomized controlled trial with recruitment from March 1, 2001, to May 31, 2002. SETTING: Nine primary care clinics from a large health maintenance organization. PARTICIPANTS: A total of 329 patients with diabetes mellitus and comorbid major depression and/or dysthymia. Intervention Patients were randomly assigned to the Pathways case management intervention (n = 164) or usual care (n = 165). The intervention provided enhanced education and support of antidepressant medication treatment prescribed by the primary care physician or problem-solving therapy delivered in primary care. MAIN OUTCOME MEASURES: Independent blinded assessments at baseline and 3, 6, and 12 months of depression (Hopkins Symptom Checklist 90), global improvement, and satisfaction with care. Automated clinical data were used to evaluate adherence to antidepressant regimens, percentage receiving specialty mental health visits, and HbA1c levels. RESULTS: When compared with usual care patients, intervention patients showed greater improvement in adequacy of dosage of antidepressant medication treatment in the first 6-month period (odds ratio [OR], 4.15; 95% confidence interval [CI], 2.28-7.55) and the second 6-month period (OR, 2.90; 95% CI, 1.69-4.98), less depression severity over time (z = 2.84, P = .004), a higher rating of patient-rated global improvement at 6 months (intervention 69.4% vs usual care 39.3%; OR, 3.50; 95% CI, 2.16-5.68) and 12 months (intervention 71.9% vs usual care 42.3%; OR, 3.50; 95% CI, 2.14-5.72), and higher satisfaction with care at 6 months (OR, 2.01; 95% CI, 1.18-3.43) and 12 months (OR, 2.88; 95% CI, 1.67-4.97). Although depressive outcomes were improved, no differences in HbA1c outcomes were observed. CONCLUSION: The Pathways collaborative care model improved depression care and outcomes in patients with comorbid major depression and/or dysthymia and diabetes mellitus, but improved depression care alone did not result in improved glycemic control.
PP - United States
PY - 2004
SN - 0003-990X; 0003-990X
SP - 1042
EP - 1049
EP - 
T1 - The Pathways Study: a randomized trial of collaborative care in patients with diabetes and depression
T2 - Archives of General Psychiatry
TI - The Pathways Study: a randomized trial of collaborative care in patients with diabetes and depression
U1 - HIT & Telehealth
U2 - 15466678
U3 - 10.1001/archpsyc.61.10.1042
VL - 61
VO - 0003-990X; 0003-990X
Y1 - 2004
ER -