|Publication Type||Journal Article|
|Source||Journal of General Internal Medicine, Volume 24, Issue Suppl 2, p.S417 - S424 (2009)|
|Year of Publication||2009|
|Authors||Fann, J. R.; M. Fan, and J. Unutzer|
|Journal||Journal of General Internal Medicine|
|Selection||Education & workforce|
Abstract.Background: Depression is common among older cancer patients, but little is known about the optimal approach to caring for this population. This analysis evaluates the effectiveness of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) program, a stepped care management program for depression in primary care patients who had an ICD-9 cancer diagnosis. Methods: Two hundred fifteen cancer patients were identified from the 1,801 participants in the parent study. Subjects were 60 years or older with major depression (18%), dysthymic disorder (33%), or both (49%), recruited from 18 primary care clinics belonging to 8 health-care organizations in 5 states. Patients were randomly assigned to the IMPACT intervention (n=112) or usual care (n=103). Intervention patients had access for up to 12 months to a depression care manager who was supervised by a psychiatrist and a primary care provider and who offered education, care management, support of antidepressant management, and brief, structured psychosocial interventions including behavioral activation and problem-solving treatment. Results: At 6 and 12 months, 55% and 39% of intervention patients had a 50% or greater reduction in depressive symptoms (SCL-20) from baseline compared to 34% and 20% of usual care participants (P=0.003 and P=0.029). Intervention patients also experienced greater remission rates (P=0.031), more depression-free days (P<0.001), less functional impairment (P=0.011), and greater quality of life (P=0.039) at 12 months than usual care participants. Conclusions: The IMPACT collaborative care program appears to be feasible and effective for depression among older cancer patients in diverse primary care settings.
|View in Pubmed||Pubmed|