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Care management for depression and osteoarthritis pain in older primary care patients: a pilot study
Author(s) -
Unützer Jürgen,
Hantke Melinda,
Powers Diane,
Higa Lori,
Lin Elizabeth,
D. Vannoy Steven,
Thielke Stephen,
Fan MingYu
Publication year - 2008
Publication title -
international journal of geriatric psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.28
H-Index - 129
eISSN - 1099-1166
pISSN - 0885-6230
DOI - 10.1002/gps.2048
Subject(s) - medicine , depression (economics) , physical therapy , osteoarthritis , intervention (counseling) , randomized controlled trial , primary care , brief pain inventory , chronic pain , psychiatry , alternative medicine , family medicine , pathology , economics , macroeconomics
Objective To establish the feasibility of and to generate preliminary evidence for the efficacy of a care management program addressing both physical and emotional pain associated with late‐life depression and osteoarthritis. Methods Treatment development pilot study in three university affiliated primary care clinics. Participants were patients 60 years or older with depression and osteoarthritis pain. The intervention entailed a nurse administered care management program supporting depression and arthritis treatment by primary care physicians. Outcomes include depression, pain severity and functional impairment from pain assessed at baseline and 6 months. Results Fourteen patients participated in the pilot program. Between baseline and 6 months, mean HSCL‐20 depression scores dropped from 1.78 (SD 0.56) to 1.06 (SD 0.59), a standardized effect size of 1.27 ( p = 0.004). Pain intensity scores dropped from 5.67 (SD 1.69) to 4.18 (SD 1.98), an effect size of 0.88 ( p = 0.021) and pain interference scores dropped from 4.91 (SD 1.75) to 3.49 (SD 2.14), an effect size of 0.81 ( p = 0.013). Patients also experienced improvements in self efficacy, in satisfaction with depression care, and in timed 8‐m walk and transfer tests. Conclusion The combined intervention was feasible and well‐received by patients. Preliminary outcomes are promising and comparisons to an earlier trial of care management for depression alone suggest that the combined program may be equally effective for depression but more effective for pain. Copyright © 2008 John Wiley & Sons, Ltd.