Living Well with Chronic Illness A Call for Public Health Action (2012) / Chapter Skim
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Appendix A: Improving Recognition and Quality of Depression Care in Patients with Common Chronic Medical Illnesses--Wayne J. Katon
Appendix A: Improving Recognition and Quality of Depression Care in Patients with Common Chronic Medical Illnesses--Wayne J. Katon
Pages 261-284
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From page 261... ...
Given the high prevalence of chronic illness in aging populations, improving guideline-based management of the most common chronic illnesses, such as diabetes, heart disease, asthma and chronic obstructive pulmonary disease (COPD) , cancer, and depression, would also have a major public health impact in improving successful aging (Mor, 2005)
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. Patients with chronic medical illness have been found to have two- to threefold higher rates of major depression compared with age- and gendermatched primary care controls (Katon, 2011)
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Katon, Clinical health services and relationship between A-1.eps major depression, depressive symptoms, and general medical illness, 216–226, 2003, with permission from Elsevier. 263 bitmap, landscape
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, decreased mobility due to chronic medical illnesses and functional decline, and less knowledge about mental illness in this population (Unützer et al., 2000; Van Citters and Bartels, 2004)
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265 APPENDIX A FIGURE A-2 Relationship of depression and diabetes symptoms. SOURCE: Ludman et al., 2004.
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. COMMUNITY-BASED PUBLIC HEALTH PLATFORMS A recent meta-analysis that evaluated face-to-face psychological services for adults ages 65 and older with mental illness identified 14 studies, including 5 randomized controlled trials (Van Citters and Bartels, 2004)
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From page 267... ...
Positive scores then led to screening with a structured psychiatric interview, and clients with either minor depression or dysthmia were offered randomization to the study intervention compared with usual care. This intervention significantly increased the percentage of patients with at least a 50 percent decrease in depressive symptoms or remission of depressive symptoms (Ciechanowski et al., 2004)
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. Rabins et al., examined in a randomized controlled trial the effect of a multidisciplinary care protocol and nurse-based outreach to 298 seniors living in public housing (Rabins et al., 2000)
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Since most patients with comorbid depression and chronic medical illness are seen by primary care physicians and/or medical specialists, integrating depression services into these systems of care is a logical way to deliver mental health services to larger populations. Collaborative care models have been shown to be effective in improving the quality of depression care and depression outcomes compared with usual primary care in a wide range of primary care populations, from adolescent (Asarnow et al., 2005)
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From page 270... ...
The psychiatrist advises primary care providers about diagnostic and therapeutic approaches if patients are not improving with initial treatments, and they may provide in-person consultation for selected patients with persistent symptoms or diagnostic complexity. Collaborative care models have been tested in over 40 primary care–based randomized controlled trials and have been shown to be more effective than usual primary care in improving quality of depression care and depression and functional outcomes for up to 2 years (Gilbody et al., 2006)
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From page 271... ...
. Strong and colleagues randomized 200 patients with comorbid depression and cancer to collaborative care and usual care (Strong et al., 2008)
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. A new multicondition collaborative care intervention program has been shown to improve depression, glucose, blood pressure and low-density lipoprotein cholesterol, and functional outcomes compared with usual care in patients with poorly controlled diabetes and/or coronary heart disease and comorbid depression (Katon et al., 2010a)
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The GRACE model tested a home-based care management intervention by a nurse practitioner and a social worker who collaborated with the primary care physician and a geriatrics interdisciplinary team (Counsell et al., 2007)
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These trials need replication in larger numbers of patients meeting criteria for major depression or dysthymia. HEALTH POLICY CHANGES THAT COULD IMPROVE QUALITY AND OUTCOMES OF DEPRESSION CARE Berwick has emphasized that major organizational changes will be necessary for medical care systems to adapt existing primary care and medical specialty services to optimize care of patients with chronic illnesses, such as depression or diabetes (Berwick et al., 2003)
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From page 275... ...
. Increasing demand will necessitate education of consumer groups, employers, and insurers about cost-effective models to improve depression care, including information on how these models may decrease overall medical costs in patients with comorbid medical illnesses, such as diabetes (Katon and Seelig, 2008b)
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From page 276... ...
Payments to health organizations that report improvement in percentage of patients with at least a 50 percent improvement in their initial level of depressive symptoms at 3 and 6 months could also increase motivation for systems of care to integrate evidence-based models of care. PREVENTION OF DEPRESSION IN PATIENTS WITH CHRONIC MEDICAL ILLNESSES Preventive interventions to decrease incidence of depression in patients with chronic medical illness have been developed in recent years.
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. Pitceathly and colleagues tested a brief psychological intervention versus usual care in a large sample of patients recently diagnosed with cancer (Pitceathly et al., 2009)
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, but there are major gaps in recognition and quality of care for this affective illness. Interventions have been developed and integrated into both community-based public health platforms and primary care platforms and have been shown in randomized controlled trials to improve depression and functional outcomes.
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2010. Enhanced depression care for patients with acute coronary syndrome and persistent depressive symptoms: Coronary psychosocial evaluation studies randomized controlled trial.
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2010. Collaborative care management of major depression among low-income, predomi nantly Hispanic subjects with diabetes: A randomized controlled trial.
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Cost-effectiveness of a multi-condition collab orative care intervention: A randomized controlled trial. Archives of General Psychiatry.
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2003. Effect of improving depression care on pain and functional outcomes among older adults with arthritis: A randomized controlled trial.
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2002. Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial.
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2004. The effec tiveness of depression care management on diabetes-related outcomes in older patients.
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