Effect of Improving Depression Care on Pain and Functional Outcomes Among Older Adults With Arthritis

Lin, Elizabeth; Katon, Wayne; Korff, Michael Von; Tang, Lingqi; Kroenke, Kurt; Harpole, Linda H.; Hegel, Mark T.; Areán, Patricia A.; Hoffing, Marc; Penna, Richard Della; Langston, Chris

doi:10.1001/jama.290.18.2428

Cited by 570 publications

(396 citation statements)

References 53 publications

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“…In our study sample, adults with depression had higher rates of co-existing CVD 29,30 It is also evident from the results of a systematic review of 45 studies that receiving collaborative care as compared to usual care has been found to be beneficial among those with major depressive disorder for improving the treatment outcomes such as adherence and functional status, and for reducing the financial burden. 31 It has to be noted that the demonstration projects for providing coordinated care for high-cost and highneed patients have also proven to be cost-effective.…”

Section: Discussionmentioning

confidence: 63%

Healthcare Expenditures Associated with Depression Among Individuals with Osteoarthritis: Post-Regression Linear Decomposition Approach

Agarwal

Sambamoorthi

2015

J GEN INTERN MED

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BACKGROUND: Depression is common among individuals with osteoarthritis and leads to increased healthcare burden. The objective of this study was to examine excess total healthcare expenditures associated with depression among individuals with osteoarthritis in the US. DESIGN: Adults with self-reported osteoarthritis (n= 1881) were identified using data from the 2010 Medical Expenditure Panel Survey (MEPS). Among those with osteoarthritis, chi-square tests and ordinary least square regressions (OLS) were used to examine differences in healthcare expenditures between those with and without depression. Post-regression linear decomposition technique was used to estimate the relative contribution of different constructs of the Anderson's behavioral model, i.e., predisposing, enabling, need, personal healthcare practices, and external environment factors, to the excess expenditures associated with depression among individuals with osteoarthritis. All analysis accounted for the complex survey design of MEPS. KEY RESULTS: Depression coexisted among 20.6 % of adults with osteoarthritis. The average total healthcare expenditures were $13,684 among adults with depression compared to $9284 among those without depression. Multivariable OLS regression revealed that adults with depression had 38.8 % higher healthcare expenditures (p<0.001) compared to those without depression. Postregression linear decomposition analysis indicated that 50 % of differences in expenditures among adults with and without depression can be explained by differences in need factors. CONCLUSIONS: Among individuals with coexisting osteoarthritis and depression, excess healthcare expenditures associated with depression were mainly due to comorbid anxiety, chronic conditions and poor health status. These expenditures may potentially be reduced by providing timely intervention for need factors or by providing care under a collaborative care model.

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Section: Discussionmentioning

confidence: 63%

Healthcare Expenditures Associated with Depression Among Individuals with Osteoarthritis: Post-Regression Linear Decomposition Approach

Agarwal

Sambamoorthi

2015

J GEN INTERN MED

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“…Poor mental health has been associated with worse overall hip and knee OA pain and deterioration in mental health has been found to precede short term exacerbations of OA pain (30). Treatment of depression in people with arthritis appears to improve depressive symptoms, reduce OA pain, improve function and quality of life (31) and therefore is an important consideration in the management of OA.…”

Section: Psychological Factorsmentioning

confidence: 99%

Targeting Care

Eyles

Lucas

Hunter

2013

Rheumatic Disease Clinics of North America

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Important points and objectives for recall:• Numerous studies have explored patient characteristics including: body mass index, psychological factors, muscle strength, tibiofemoral alignment, radiographic changes and signs of inflammation as potential predictors of response to non-surgical interventions for management of hip and knee OA.• Often the sample sizes utilized by these studies were inadequate to yield sufficient numbers of responders to the interventions to allow for analysis of the potential predictors identified.• A number of well-designed studies were adequately powered to provide some evidence for clinical characteristics that did or did not predict response to non-surgical interventions for participants with hip and knee OA. SynopsisInternational evidence-based guidelines recommend a multitude of non-surgical treatment options for the management of OA. In the face of so many choices, it would be helpful for clinicians to be able to base treatment decisions on the identification of specific clinical presentations that foretell greater likelihood of success following a given treatment. This review summarizes the evidence available for patient characteristics that have been analysed as potential predictors of response to non-surgical interventions for patients with hip and knee OA. The specific variables targeted for this review include: body mass index, psychological factors, muscle strength, tibiofemoral alignment, radiographic changes and signs of inflammation. Several studies provide moderate to good evidence of potential predictors of response to non-surgical treatments, while areas for future research are illuminated.

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“…5 A growing number of studies of collaborative care management for depression in a wide range of health care systems, including the Veterans Health Administration (VA), show that it is more effective than usual care. [6][7][8][9][10][11] In particular, Gilbody et al conducted a comprehensive systematic review of 37 randomized trials involving 12,355 patients with depression who received primary care with integrated collaborative care. The review confirms that collaborative care, when utilized in addition to primary care, is more effective than traditional standard care in the short term, and strongly suggests that it may be more effective in the long term.…”

Section: Introductionmentioning

confidence: 99%

A Case Study of Early Experience with Implementation of Collaborative Care in the Veterans Health Administration

Tai–Seale

Kunik

Shepherd³

et al. 2010

Population Health Management

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Primary care remains critically important for those who suffer from mental disorders. Although collaborative care, which integrates mental health services into primary care, has been shown to be more effective than usual care, its implementation has been slow and the experience of providers and patients with collaborative care is less well known. The objective of this case study was to examine the effects of collaborative care on patient and primary care provider (PCP) experiences and communication during clinical encounters.Participating physicians completed a self-administered visit reconstruction questionnaire in which they logged details of patient visits and described their perceptions of the visits and the influence of collaborative care. Audio recordings of visits were analyzed to assess the extent of discussion about colocated mental health services and visit time devoted to mental health topics.The main outcome measures were the extent of discussion and recommendation for collaborative care during clinical visits and providers' experiences based on their responses to the visit reconstruction questionnaire. Providers surveyed expressed enthusiasm about collaborative care and cited the time constraint of office visits and lack of specialty support as the main reasons for limiting their discussion of mental health topics with patients.

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Effect of Improving Depression Care on Pain and Functional Outcomes Among Older Adults With Arthritis

Cited by 570 publications

References 53 publications

Healthcare Expenditures Associated with Depression Among Individuals with Osteoarthritis: Post-Regression Linear Decomposition Approach

Healthcare Expenditures Associated with Depression Among Individuals with Osteoarthritis: Post-Regression Linear Decomposition Approach

Targeting Care

A Case Study of Early Experience with Implementation of Collaborative Care in the Veterans Health Administration

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