Long-term Effects of a Collaborative Care Intervention in Persistently Depressed Primary Care Patients

Authors

  • Wayne Katon MD,

    Corresponding author
    1. Received from the Department of Psychiatry and Behavioral Sciences, University of Washington Medical School (WK, JR, EW), and the Center for Health Studies, Group Health Cooperative (MVK, EL, GS, TB, EL), Seattle, Wash.
    Search for more papers by this author
  • Joan Russo PhD,

    1. Received from the Department of Psychiatry and Behavioral Sciences, University of Washington Medical School (WK, JR, EW), and the Center for Health Studies, Group Health Cooperative (MVK, EL, GS, TB, EL), Seattle, Wash.
    Search for more papers by this author
  • Michael Von Korff ScD,

    1. Received from the Department of Psychiatry and Behavioral Sciences, University of Washington Medical School (WK, JR, EW), and the Center for Health Studies, Group Health Cooperative (MVK, EL, GS, TB, EL), Seattle, Wash.
    Search for more papers by this author
  • Elizabeth Lin MD, MPH,

    1. Received from the Department of Psychiatry and Behavioral Sciences, University of Washington Medical School (WK, JR, EW), and the Center for Health Studies, Group Health Cooperative (MVK, EL, GS, TB, EL), Seattle, Wash.
    Search for more papers by this author
  • Greg Simon MD,

    1. Received from the Department of Psychiatry and Behavioral Sciences, University of Washington Medical School (WK, JR, EW), and the Center for Health Studies, Group Health Cooperative (MVK, EL, GS, TB, EL), Seattle, Wash.
    Search for more papers by this author
  • Terry Bush PhD,

    1. Received from the Department of Psychiatry and Behavioral Sciences, University of Washington Medical School (WK, JR, EW), and the Center for Health Studies, Group Health Cooperative (MVK, EL, GS, TB, EL), Seattle, Wash.
    Search for more papers by this author
  • Evette Ludman PhD,

    1. Received from the Department of Psychiatry and Behavioral Sciences, University of Washington Medical School (WK, JR, EW), and the Center for Health Studies, Group Health Cooperative (MVK, EL, GS, TB, EL), Seattle, Wash.
    Search for more papers by this author
  • Edward Walker MD

    1. Received from the Department of Psychiatry and Behavioral Sciences, University of Washington Medical School (WK, JR, EW), and the Center for Health Studies, Group Health Cooperative (MVK, EL, GS, TB, EL), Seattle, Wash.
    Search for more papers by this author

Dr. Katon: Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington Medical School, Seattle, WA 98195 (e-mail: wkaton@u.washington.edu).

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.

Ancillary