Efficacy
of collaborative care management of late-life
depression
The
elderly suffering from depression do not
generally receive the right treatment in primary
care practices. The effectiveness of a new
collaborative care management program for
late-life depression, IMPACT (Improving
Mood-Promoting Access to Collaborative Treatment
http://www.impact.ucla.edu
), has been studied in comparison with usual
care.
A randomized controlled clinical trial enrolled
1801 patients aged 60 years or older from 18
primary care clinics from 8 health care
organizations in 5 states in the U.S. The
subjects (65% were women), diagnosed with major
depression (17%), dysthymia (30%), or both (53%)
were randomly assigned to usual care (n = 895)
with access to any available primary care or
specialty mental health care services, or to the
IMPACT program (n = 906). A depression care
manager, who was under the responsability of a
psychiatrist and a primary care expert, was
available to patients in the IMPACT group for up
to 12 months. Education, care management,
support of antidepressant management, or a brief
psychotherapy for depression were provided by
the manager.
Assessments at 12 months showed a 50% reduction
in depressive symptoms from baseline in 45% of
IMPACT patients in comparison with 19% of
patients in usual care. The IMPACT group also
showed higher rates of depression treatment,
greater satisfaction with depression care, lower
severity of depression, less functional
impairment, and a better quality of life.
These findings show that the IMPACT
collaborative care model improves the main
outcomes of depression compared with usual care
and should be applied more widely to treat
late-life depression. JAMA
288: 2836-2845, 2002