TY - JOUR
KW - Aged
KW - Antidepressive Agents/therapeutic use
KW - Case Management
KW - Cooperative Behavior
KW - Depressive Disorder/economics/therapy
KW - Family Practice/economics/organization & administration/standards
KW - Female
KW - Health Services Accessibility
KW - Health Services Research
KW - Humans
KW - Male
KW - Mental Health Services/economics/organization & administration/standards
KW - Outcome and Process Assessment (Health Care)
KW - Patient Care Team/economics
KW - Patient Education as Topic
KW - Patient Satisfaction
KW - Primary Health Care/organization & administration/standards
KW - Psychotherapy
KW - Quality of Life
KW - Social Support
KW - United States
AU - J. Unutzer
AU - W. Katon
AU - C. M. Callahan
AU - J. W. Williams
AU - E. Hunkeler
AU - L. Harpole
AU - M. Hoffing
AU - R. D. Della Penna
AU - P. H. Noel
AU - E. H. Lin
AU - P. A. Arean
AU - M. T. Hegel
AU - L. Tang
AU - T. R. Belin
AU - S. Oishi
AU - C. Langston
AU - IMPACT Investigators
A1 - 
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 depression, 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.
BT - JAMA
C5 - Key & Foundational; Healthcare Disparities
CP - 22
CY - United States
IS - 22
JF - JAMA
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 depression, 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.
PP - United States
PY - 2002
SN - 0098-7484; 0098-7484
SP - 2836
EP - 2845
EP - 
T1 - Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial
T2 - JAMA
TI - Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial
U1 - Key & Foundational; Healthcare Disparities
U2 - 12472325
VL - 288
VO - 0098-7484; 0098-7484
Y1 - 2002
ER -