Healthcare assistant case management may reduce depression symptoms in primary care patients with major depression more than usual care

2010 ◽  
Vol 15 (1) ◽  
pp. 10-11 ◽  
Author(s):  
T. Kendrick
Keyword(s):  
Primary Care ◽  
Major Depression ◽  
Case Management ◽  
Usual Care ◽  
Depression Symptoms ◽  
Primary Care Patients ◽  
Healthcare Assistant

scholarly journals Physical exercise for late-life major depression

2015 ◽  
Vol 207 (3) ◽  
pp. 235-242 ◽  
Author(s):  
M. Belvederi Murri ◽  
M. Amore ◽  
M. Menchetti ◽  
G. Toni ◽  
F. Neviani ◽  
...  
Keyword(s):  
Primary Care ◽  
Major Depression ◽  
Physical Exercise ◽  
Primary Outcome ◽  
Rating Scale ◽  
Late Life ◽  
Lower Intensity ◽  
Progressive Exercise ◽  
Primary Care Patients ◽  
Hamilton Rating Scale

BackgroundInterventions including physical exercise may help improve the outcomes of late-life major depression, but few studies are available.AimsTo investigate whether augmenting sertraline therapy with physical exercise leads to better outcomes of late-life major depression.MethodPrimary care patients (>65 years) with major depression were randomised to 24 weeks of higher-intensity, progressive aerobic exercise plus sertraline (S+PAE), lower-intensity, non-progressive exercise plus sertraline (S+NPE) and sertraline alone. The primary outcome was remission (a score of $10 on the Hamilton Rating Scale for Depression).ResultsA total of 121 patients were included. At study end, 45% of participants in the sertraline group, 73% of those in the S+NPE group and 81% of those in the S+PAE group achieved remission (P = 0.001). A shorter time to remission was observed in the S+PAE group than in the sertraline-only group.ConclusionsPhysical exercise may be a safe and effective augmentation to antidepressant therapy in late-life major depression.

scholarly journals Intensive psychotherapy and case management for Karen refugees with Major Depression in primary care: a pragmatic randomized control trial

2019 ◽  
Author(s):  
Andrea Northwood ◽  
Maria M Vukovich ◽  
Alison Beckman ◽  
Jeffrey P Walter ◽  
Novia Josiah ◽  
...  
Keyword(s):  
Primary Care ◽  
Major Depression ◽  
Case Management ◽  
Social Functioning ◽  
Randomized Control Trial ◽  
Primary Care Providers ◽  
Care Providers ◽  
Randomized Control ◽  
Karen Refugees ◽  
Intensive Psychotherapy

Abstract Background: Despite an unparalleled global refugee crisis, there are almost no studies in primary care addressing real-world conditions and longer courses of treatment that are typical when resettled refugees present to their physician with critical psychosocial needs and complex symptoms. We studied the effects of a year of psychotherapy and case management in a primary care setting on common symptoms and functioning for Karen refugees (a newly arrived population in St Paul, Minnesota) with depression. Methods: A pragmatic parallel-group randomized control trial was conducted at two primary care clinics with large resettled Karen refugee patient populations, with simple random allocation to one year of either: (1) intensive psychotherapy and case management (IPCM), or (2) care-as-usual (CAU). Eligibility criteria included Major Depression diagnosis determined by structured diagnostic clinical interview, Karen refugee, ages 18-65. IPCM (n=112) received a year of psychotherapy and case management coordinated onsite between the case manager, psychotherapist, and primary care providers; CAU (n=102) received care-as-usual from their primary care clinic, including behavioral health referrals and/or brief onsite interventions. Blinded assessors collected outcomes of mean changes in depression and anxiety symptoms (measured by Hopkins Symptom Checklist-25), PTSD symptoms (Posttraumatic Diagnostic Scale), pain (internally developed 5-item Pain Scale), and social functioning (internally developed 37-item instrument standardized on refugees) at baseline, 3, 6 and 12 months. After propensity score matching, data were analyzed with the intention-to-treat principle using repeated measures ANOVA with partial eta-squared estimates of effect size. Results: Of 214 participants, 193 completed a baseline and follow up assessment (90.2%). IPCM patients showed significant improvements in depression, PTSD, anxiety, and pain symptoms and in social functioning at all time points, with magnitude of improvement increasing over time. CAU patients did not show significant improvements. The largest mean differences observed between groups were in depression (difference, 5.5, 95% CI, 3.9 to 7.1, P <.001) and basic needs/safety (difference, 5.4, 95% CI, 3.8 to 7.0, P <.001). Conclusions: Adult Karen refugees with depression benefited from intensive psychotherapy and case management coordinated and delivered under usual conditions in primary care. Intervention effects strengthened at each interval, suggesting robust recovery is possible.

Incremental cost-effectiveness of a collaborative care intervention for panic disorder

2006 ◽  
Vol 36 (3) ◽  
pp. 353-363 ◽  
Author(s):  
WAYNE KATON ◽  
JOAN RUSSO ◽  
CATHY SHERBOURNE ◽  
MURRAY B. STEIN ◽  
MICHELLE CRASKE ◽  
...  
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Panic Disorder ◽  
Incremental Cost ◽  
Usual Care ◽  
Moderate Increase ◽  
Patient Costs ◽  
Care Intervention ◽  
Life Years ◽  
Primary Care Patients

Background. Panic disorder is a prevalent, often disabling, disorder among primary-care patients, but there are large gaps in quality of treatment in primary care. This study describes the incremental cost-effectiveness of a combined cognitive behavioral therapy (CBT) and pharmacotherapy intervention for patients with panic disorder versus usual primary-care treatment.Method. This randomized control trial recruited 232 primary-care patients meeting DSM-IV criteria for panic disorder from March 2000 to March 2002 from six primary-care clinics from university-affiliated clinics at the University of Washington (Seattle) and University of California (Los Angeles and San Diego). Patients were randomly assigned to receive either treatment as usual or a combined CBT and pharmacotherapy intervention for panic disorder delivered in primary care by a mental health therapist. Intervention patients had up to six sessions of CBT modified for the primary-care setting in the first 12 weeks, and up to six telephone follow-ups over the next 9 months. The primary outcome variables were total out-patient costs, anxiety-free days (AFDs) and quality adjusted life-years (QALYs).Results. Relative to usual care, intervention patients experienced 60·4 [95% confidence interval (CI) 42·9–77·9] more AFDs over a 12-month period. Total incremental out-patient costs were $492 higher (95% CI $236–747) in intervention versus usual care patients with a cost per additional AFD of $8.40 (95% CI $2.80–14.0) and a cost per QALY ranging from $14158 (95% CI $6791–21496) to $24776 (95% CI $11885–37618). The cost per QALY estimate is well within the range of other commonly accepted medical interventions such as statin use and treatment of hypertension.Conclusions. The combined CBT and pharmacotherapy intervention was associated with a robust clinical improvement compared to usual care with a moderate increase in ambulatory costs.

Does patient–provider gender concordance affect mental health care received by primary care patients with major depression?

2006 ◽  
Vol 16 (3) ◽  
pp. 122-132 ◽  
Author(s):  
Kitty S. Chan ◽  
Chloe E. Bird ◽  
Robert Weiss ◽  
Naihua Duan ◽  
Lisa S. Meredith ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Major Depression ◽  
Mental Health Care ◽  
Gender Concordance ◽  
Primary Care Patients
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