Achieving Effective Antidepressant Pharmacotherapy in Primary Care: The Role of Depression Care Management in Treating Late-Life Depression

Authors

  • Yuhua Bao PhD,

    1. From the *Division of Health Policy, Department of Public Health, Weill Cornell Medical College, New York, NewYork; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MichiganCenter for Clinical Management Research and §National Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor Veterans Affairs, Ann Arbor, Michigan; and Department of Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania #Department of Psychiatry, Weill Cornell Medical College, New York, New York.
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  • Edward P. Post MD, PhD,

    1. From the *Division of Health Policy, Department of Public Health, Weill Cornell Medical College, New York, NewYork; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MichiganCenter for Clinical Management Research and §National Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor Veterans Affairs, Ann Arbor, Michigan; and Department of Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania #Department of Psychiatry, Weill Cornell Medical College, New York, New York.
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  • Thomas R. Ten Have PhD,

    1. From the *Division of Health Policy, Department of Public Health, Weill Cornell Medical College, New York, NewYork; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MichiganCenter for Clinical Management Research and §National Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor Veterans Affairs, Ann Arbor, Michigan; and Department of Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania #Department of Psychiatry, Weill Cornell Medical College, New York, New York.
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  • Bruce R. Schackman PhD,

    1. From the *Division of Health Policy, Department of Public Health, Weill Cornell Medical College, New York, NewYork; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MichiganCenter for Clinical Management Research and §National Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor Veterans Affairs, Ann Arbor, Michigan; and Department of Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania #Department of Psychiatry, Weill Cornell Medical College, New York, New York.
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  • Martha L. Bruce PhD

    1. From the *Division of Health Policy, Department of Public Health, Weill Cornell Medical College, New York, NewYork; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MichiganCenter for Clinical Management Research and §National Serious Mental Illness Treatment Research and Evaluation Center, Ann Arbor Veterans Affairs, Ann Arbor, Michigan; and Department of Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania #Department of Psychiatry, Weill Cornell Medical College, New York, New York.
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Address correspondence to Yuhua Bao, 411 E. 69th St., New York, NY 10021. E-mail: yub2003@med.cornell.edu

Abstract

OBJECTIVES: To estimate the effect of an evidence-based depression care management (DCM) intervention on the initiation and appropriate use of antidepressant in primary care patients with late-life depression.

DESIGN: Secondary analysis of data from a randomized trial.

SETTING: Community, primary care.

PARTICIPANTS: Randomly selected individuals aged 60 and older with routine appointments at 20 primary care clinics randomized to provide a systematic DCM intervention or care as usual.

METHODS: Rates of antidepressant use and dose adequacy of patients in the two study arms were compared at each patient assessment (baseline, 4, 8, and 12 months). For patients without any antidepressant treatment at baseline, a longitudinal analysis was conducted using multilevel logistic models to compare the rate of antidepressant treatment initiation, dose adequacy when initiation was first recorded, and continued therapy for at least 4 months after initiation between study arms. All analyses were conducted for the entire sample and then repeated for the subsample with major or clinically significant minor depression at baseline.

RESULTS: Rates of antidepressant use and dose adequacy increased over the first year in patients assigned to the DCM intervention, whereas the same rates held constant in usual care patients. In longitudinal analyses, the DCM intervention had a significant effect on initiation of antidepressant treatment (adjusted odds ratio (OR)=5.63, P<.001) and continuation of antidepressant medication for at least 4 months (OR=6.57, P=.04) for patients who were depressed at baseline.

CONCLUSIONS: Evidence-based DCM models are highly effective at improving antidepressant treatment in older primary care patients.

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