Three months after enrolling in a disease management program offered by telephone, patients with acute depression were six times more likely to have their symptoms reduced to a low level than those who received the standard care of diagnosis and education about their condition.
Primary care doctors participating in the program were also more apt to use nationally approved guidelines in treating their patients, say David W. Oslin, M.D., of the University of Pennsylvania and colleagues.
Patients in the program who needed changes to their therapy during the follow-up treatment period were seven times more likely to get care in line with guidelines for depression therapy established by the Agency for Health Research and Quality, according to the researchers.
Treatment provided through the phone program included many more opportunities for feedback and monitoring of patients as they continued with their care -- a strategy that had been tested previously in face-to-face follow-up treatments.
The new findings "suggest that beneficial results are possible when delivering disease management exclusively by telephone," Oslin says in the May issue of General Hospital Psychiatry.
Phone contact between the patients and specially trained nurses was used to support the primary care doctor in treating acute depression. The nurses monitored symptoms and treatment outcomes at three-week intervals, reporting the results back to each patient's primary care doctor.
Although doctors were more likely to prescribe guideline-recommended care for their patients in the phone program, the patients themselves were not any more likely to follow their doctor's orders than patients receiving standard care, according to the researchers.
"If we can identify significant patient characteristics that predict non-adherence, then an intervention or educational program could be directed to these patients in order to improve their engagement in the management of their depression," Oslin says.
Oslin and colleagues hope that the phone program will help primary care doctors treat more patients with depression, by making it easier to schedule follow-up visits and allowing several clinics to share the costs of specialists trained in depression disease management.
"Depression in primary care is a pressing public health problem. More depressed patients of all ages are seen by primary care clinicians than by specialty mental health providers," Oslin says.
The study was supported by the University of Pennsylvania Health System and the National Institute of Mental Health.
FOR MORE INFORMATION
Health Behavior News Service: 202-387-2829 or www.hbns.org.
Interviews: Contact David Oslin at 215-615-3083 or oslin@mail.med.upenn.edu.
General Hospital Psychiatry: Contact Don R. Lipsitt, M.D., at 617-661-3544.
BY BECKY HAM, STAFF WRITER
HEALTH BEHAVIOR NEWS SERVICE
Journal
General Hospital Psychiatry