Dataset Information

Improving primary care for older adults with cancer and depression.

ABSTRACT: BACKGROUND: Depression is common among older cancer patients, but little is known about the optimal approach to caring for this population. This analysis evaluates the effectiveness of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) program, a stepped care management program for depression in primary care patients who had an ICD-9 cancer diagnosis. METHODS: Two hundred fifteen cancer patients were identified from the 1,801 participants in the parent study. Subjects were 60 years or older with major depression (18%), dysthymic disorder (33%), or both (49%), recruited from 18 primary care clinics belonging to 8 health-care organizations in 5 states. Patients were randomly assigned to the IMPACT intervention (n = 112) or usual care (n = 103). Intervention patients had access for up to 12 months to a depression care manager who was supervised by a psychiatrist and a primary care provider and who offered education, care management, support of antidepressant management, and brief, structured psychosocial interventions including behavioral activation and problem-solving treatment. RESULTS: At 6 and 12 months, 55% and 39% of intervention patients had a 50% or greater reduction in depressive symptoms (SCL-20) from baseline compared to 34% and 20% of usual care participants (P = 0.003 and P = 0.029). Intervention patients also experienced greater remission rates (P = 0.031), more depression-free days (P < 0.001), less functional impairment (P = 0.011), and greater quality of life (P = 0.039) at 12 months than usual care participants. CONCLUSIONS: The IMPACT collaborative care program appears to be feasible and effective for depression among older cancer patients in diverse primary care settings.

SUBMITTER: Fann JR

PROVIDER: S-EPMC2763171 | biostudies-other | 2009 Nov

REPOSITORIES: biostudies-other

ACCESS DATA

Similar Datasets

Project description:ObjectiveTo investigate whether an intervention to improve treatment of depression in older adults in primary care modified the increased risk of death associated with depression.DesignLong term follow-up of multi-site practice randomized controlled trial (PROSPECT-Prevention of Suicide in Primary Care Elderly: Collaborative Trial).Setting20 primary care practices in New York City, Philadelphia, and Pittsburgh, USA, randomized to intervention or usual care.Participants1226 participants identified between May 1999 and August 2001 through a two stage, age stratified (60-74; ≥ 75 years) depression screening of randomly sampled patients; enrollment included patients who screened positive and a random sample of patients who screened negative.InterventionFor two years, a depression care manager worked with primary care physicians in intervention practices to provide algorithm based care for depression, offering psychotherapy, increasing antidepressant dose if indicated, and monitoring symptoms, adverse effects of drugs, and adherence to treatment. This paper reports the long term follow-up.Main outcome measureMortality risk based on a median follow-up of 98 (range 0.8-116.4) months through 2008.ResultsIn baseline clinical interviews, 396 people were classified as having major depression, 203 had clinically significant minor depression, and 627 did not meet criteria for depression. At follow-up, 405 patients had died. Patients with major depression in usual care were more likely to die than were those without depression (hazard ratio 1.90, 95% confidence interval 1.57 to 2.31). In contrast, patients with major depression in intervention practices were at no greater risk than were people without depression (hazard ratio 1.09, 0.83 to 1.44). Patients with major depression in intervention practices, relative to usual care, were 24% less likely to have died (hazard ratio 0.76, 0.57 to 1.00; P=0.05). Preliminary data on cause of death are provided. No significant effect on mortality was found for minor depression.ConclusionsOlder adults with major depression in practices provided with additional resources to intensively manage depression had a mortality risk lower than that observed in usual care and similar to older adults without depression.Trial registrationClinical trials NCT00000367.

Dataset Information

Improving primary care for older adults with cancer and depression.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure