TY - JOUR
T1 - Collaborative care for depression symptoms in an outpatient cardiology setting
T2 - A randomized clinical trial
AU - Carney, Robert M.
AU - Freedland, Kenneth E.
AU - Steinmeyer, Brian C.
AU - Rubin, Eugene H.
AU - Ewald, Gregory
N1 - Publisher Copyright:
© 2016 Elsevier Ireland Ltd.
PY - 2016/9/15
Y1 - 2016/9/15
N2 - Background Depression is a risk factor for morbidity and mortality in patients with coronary heart disease. Finding effective methods for identifying and treating depression in these patients is a high priority. The purpose of this study was to determine whether collaborative care (CC) for patients who screen positive for depression during an outpatient cardiology visit results in greater improvement in depression symptoms and better medical outcomes than seen in patients who screen positive for depression but receive only usual care (UC). Methods Two hundred-one patients seen in an outpatient cardiology clinic who screened positive for depression during an outpatient visit were randomized to receive either CC or UC. Recommendations for depression treatment and ongoing support and monitoring of depression symptoms were provided to CC patients and their primary care physicians (PCPs) for up to 6 months. Results There were no differences between the arms in mean Beck Depression Inventory-II scores(CC, 15.9; UC, 17.4; p =.45) or in depression remission rates(CC, 32.5%; UC, 26.2%; p = 0.34) after 6 months, or in the number of hospitalizations after 12 months (p = 0.73). There were fewer deaths among the CC (1/100) than UC patients (8/101) (p = 0.03). Conclusions This trial did not show that CC produces better depression outcomes than UC. Screening led to a higher rate of depression treatment than was expected in the UC group, and delays in obtaining depression treatment from PCPs may have reduced treatment effectiveness for the CC patients. A different strategy for depression treatment following screening in outpatient cardiology services is needed.
AB - Background Depression is a risk factor for morbidity and mortality in patients with coronary heart disease. Finding effective methods for identifying and treating depression in these patients is a high priority. The purpose of this study was to determine whether collaborative care (CC) for patients who screen positive for depression during an outpatient cardiology visit results in greater improvement in depression symptoms and better medical outcomes than seen in patients who screen positive for depression but receive only usual care (UC). Methods Two hundred-one patients seen in an outpatient cardiology clinic who screened positive for depression during an outpatient visit were randomized to receive either CC or UC. Recommendations for depression treatment and ongoing support and monitoring of depression symptoms were provided to CC patients and their primary care physicians (PCPs) for up to 6 months. Results There were no differences between the arms in mean Beck Depression Inventory-II scores(CC, 15.9; UC, 17.4; p =.45) or in depression remission rates(CC, 32.5%; UC, 26.2%; p = 0.34) after 6 months, or in the number of hospitalizations after 12 months (p = 0.73). There were fewer deaths among the CC (1/100) than UC patients (8/101) (p = 0.03). Conclusions This trial did not show that CC produces better depression outcomes than UC. Screening led to a higher rate of depression treatment than was expected in the UC group, and delays in obtaining depression treatment from PCPs may have reduced treatment effectiveness for the CC patients. A different strategy for depression treatment following screening in outpatient cardiology services is needed.
KW - Collaborative care
KW - Depression
KW - Outpatient cardiology
UR - http://www.scopus.com/inward/record.url?scp=84976361818&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2016.06.045
DO - 10.1016/j.ijcard.2016.06.045
M3 - Article
C2 - 27327502
AN - SCOPUS:84976361818
SN - 0167-5273
VL - 219
SP - 164
EP - 171
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -