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Research ArticleOriginal Research

Long-Term Clinical Outcomes of Care Management for Chronically Depressed Primary Care Patients: A Report From the Depression in Primary Care Project

Michael S. Klinkman, Sabrina Bauroth, Stacey Fedewa, Kevin Kerber, Julie Kuebler, Tanya Adman and Ananda Sen
The Annals of Family Medicine September 2010, 8 (5) 387-396; DOI: https://doi.org/10.1370/afm.1168
Michael S. Klinkman
MD, MS
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Sabrina Bauroth
MSW
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Stacey Fedewa
MPH
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Kevin Kerber
MD
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Julie Kuebler
CNP
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Tanya Adman
MSW
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Ananda Sen
PhD
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Abstract

PURPOSE Recent studies examining depression disease management report improvements in short-term outcomes, but less is known about whether improvements are sustainable over time. This study evaluated the sustained clinical effectiveness of low-intensity depression disease management in chronically depressed patients.

METHODS The Depression in Primary Care (DPC) intervention was introduced in 5 primary care practices in the University of Michigan Health System, with 5 matched practices selected as control sites. Clinicians were free to refer none, some, or all of their depressed patients at their discretion. Core clinical outcomes of remission and serial change in Patient Health Questionnaire (PHQ-8) scores for 728 DPC enrollees observed for up to 18 months after enrollment were compared with those for 78 patients receiving usual care who completed mailed questionnaires at baseline, 6, 12, and 18 months.

RESULTS DPC enrollees had sustained improvement in remission rates and reduced-function days over the full 18 months. Mean change in the PHQ-8 score over each 6-month interval was more favorable for DPC enrollees than for usual care patients, and the proportion of DPC enrollees in remission was higher at 6 months (43.4% vs 33.3%; P = .11), 12 months (52.0% vs 33.9%; P=.012), and 18 months (49.2% vs 27.3%; P = .004). Multivariate analysis controlling for age, sex, ethnicity, baseline severity, and comorbid medical illness confirmed that DPC enrollees had significantly more reduction in depressive symptom burden over 18 months.

CONCLUSIONS The DPC intervention produced sustained improvement in clinical outcomes over 18 months in a cohort of chronically depressed patients with persistent symptoms despite active treatment.

  • Depression
  • mental health
  • chronic disease
  • disease management
  • regression analysis
  • Received for publication September 29, 2009.
  • Revision received March 12, 2010.
  • Accepted for publication March 17, 2010.
  • © 2010 Annals of Family Medicine, Inc.
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The Annals of Family Medicine: 8 (5)
The Annals of Family Medicine: 8 (5)
Vol. 8, Issue 5
1 Sep 2010
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Long-Term Clinical Outcomes of Care Management for Chronically Depressed Primary Care Patients: A Report From the Depression in Primary Care Project
Michael S. Klinkman, Sabrina Bauroth, Stacey Fedewa, Kevin Kerber, Julie Kuebler, Tanya Adman, Ananda Sen
The Annals of Family Medicine Sep 2010, 8 (5) 387-396; DOI: 10.1370/afm.1168

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Long-Term Clinical Outcomes of Care Management for Chronically Depressed Primary Care Patients: A Report From the Depression in Primary Care Project
Michael S. Klinkman, Sabrina Bauroth, Stacey Fedewa, Kevin Kerber, Julie Kuebler, Tanya Adman, Ananda Sen
The Annals of Family Medicine Sep 2010, 8 (5) 387-396; DOI: 10.1370/afm.1168
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