Organized Care for Depression Improves Outcomes and Reduces Costs

Simon GE, Katon WJ, Lin EH, Rutter C, Manning WG, Von Korff M, Ciechanowski P, Ludman EJ, Young BA: Cost-effectiveness of systematic depression treatment among people with diabetes mellitus. Arch Gen Psychiatry 64:65 -72, 2007[OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4]Design. A randomized controlled trial and economic analysis.Subjects. Three hundred twenty-nine patients with diabetes and a current depressive disorder.Methods. Researchers identified from computer records 9,063 patients with diabetes from nine primary care clinics affiliated with Group Health Cooperative and mailed them a survey that included the nine-item Patient Health Questionnaire (PHQ-9), a well-validated depression screening instrument. Those scoring 10 or more on the PHQ-9 on two separate occasions and who were found to have moderate or greater symptoms with the Hopkins Symptom Check List (SCL) were invited to an in-person baseline visit. Three hundred twenty-nine patients attended and were randomized to a nurse-delivered multi-component depression management program or usual care.The program used a stepped-care approach with incorporation of patient preferences for treatment (antidepressant medication, structured psychotherapy, or both). Follow-up was delivered with a combination of in-person and phone-based visits. Outcomes were measured by blinded telephone-based assessments at 3, 6, 12, and 24 months. The main … [1]: {openurl}?query=rft.jtitle%253DArchives%2Bof%2BGeneral%2BPsychiatry%26rft.stitle%253DArch%2BGen%2BPsychiatry%26rft.issn%253D0003-990X%26rft.aulast%253DSimon%26rft.auinit1%253DG.%2BE.%26rft.volume%253D64%26rft.issue%253D1%26rft.spage%253D65%26rft.epage%253D72%26rft.atitle%253DCost-effectiveness%2Bof%2BSystematic%2BDepression%2BTreatment%2BAmong%2BPeople%2BWith%2BDiabetes%2BMellitus%26rft_id%253Dinfo%253Adoi%252F10.1001%252Farchpsyc.64.1.65%26rft_id%253Dinfo%253Apmid%252F17199056%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1001/archpsyc.64.1.65&link_type=DOI [3]: /lookup/external-ref?access_num=17199056&link_type=MED&atom=%2Fdiaclin%2F26%2F1%2F15.atom [4]: /lookup/external-ref?access_num=000243273200008&link_type=ISI