Impact of Disseminating Quality Improvement Programs for Depression in Managed Primary Care

Wells, Kenneth B.; Sherbourne, Cathy D.; Schoenbaum, Michael; Duan, Naihua; Meredith, Lisa S.; Unützer, Jürgen; Miranda, Jeanne; Carney, Maureen F.; Rubenstein, Lisa V.

doi:10.1001/jama.283.2.212

Cited by 937 publications

(774 citation statements)

References 37 publications

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“…82 Organized follow-up programs that include patient education, telephone or in-person contact every 2 to 4 weeks, monitoring of medication adherence, and psychiatric consultation as necessary improve outcomes for depressed cardiac patients. [83][84][85][86] "Measurement-based care," which uses frequent ratings of symptoms and adverse effects to guide dose adjustments and changes in treatment, can also be of benefit. 87 If antidepressant medication does not improve symptoms by 4 weeks and adverse effects are tolerable, the initial medication dose should be doubled.…”

Section: How Should Cardiac Patients Be Followed Up After Initiating mentioning

confidence: 99%

Depression and Cardiovascular Disease

Whooley¹

2006

JAMA

219

163

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Major depressive disorder is a risk factor for the development of incident coronary heart disease events in healthy patients and for adverse cardiovascular outcomes in patients with established heart disease. Depression is present in 1 of 5 outpatients with coronary heart disease and in 1 of 3 outpatients with congestive heart failure, yet the majority of cases are not recognized or appropriately treated. It is not known whether treating depression improves cardiovascular outcomes, but antidepressant treatment with selective serotonin reuptake inhibitors is generally safe, alleviates depression, and improves quality of life. This article evaluates the importance of major depression in patients with cardiovascular disease, and provides practical guidance for identifying and treating this disorder. CASE PRESENTATIONA 58-year-old man with a history of coronary heart disease (CHD), type 2 diabetes mellitus, hypertension, smoking, and alcohol dependence presented for routine medical care. He had initially sought medical attention for exertional angina 5 years previously, at which time he underwent exercise treadmill testing with thallium that was positive for reversible perfusion defects in the anterior, septal, and inferior walls. Subsequent coronary angiography revealed diffuse heavy calcifications in the left anterior descending artery with a moderate lesion prior to the first diagonal. Several major septal perforators had significant lesions at their origins. In the dominant right coronary artery, there were diffuse calcifications but no significant lesions. The left circumflex and large ramus intermedius were free of discrete lesions. Left ventricular function was normal.The patient underwent single-vessel (left internal mammary artery to left anterior descending artery) coronary artery bypass grafting (CABG) surgery. He was prescribed atenolol 100 mg/ d, lisinopril 40 mg/d, lovastatin 80 mg/d, aspirin 325 mg/d, metformin 850 mg 3 times a day, and glipizide 10 mg 2 times a day. Despite being nonadherent to his prescribed medications, he remained stable for 5 years, but then one day, while doing household chores, he suddenly developed chest pressure, shortness of breath, and diaphoresis that lasted 12 hours. On admission to the hospital his troponin I was elevated and peaked at 0.7 ng/mL (normal, <0.05 ng/mL), consistent with a myocardial infarction (MI). His electrocardiogram had not changed.

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Section: How Should Cardiac Patients Be Followed Up After Initiating mentioning

confidence: 99%

Depression and Cardiovascular Disease

Whooley¹

2006

JAMA

219

163

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“…chronic conditions including depression Hunkeler et al, 2000;Katzelnick et al, 2000;Rost, Nutting, Smith, Werner, & Duan, 2001;Simon, Von Korff, Rutter, & Wagner, 2000;Unutzer et al, 2002;Wells et al, 2000), anxiety (Roy-Byrne, Katon, Cowley, & Russo, 2001), alcohol use disorders (Oslin et al, 2003), and physical health conditions (Aubert et al, 1998;Delaronde, 2002;Rich et al, 1995), at a lower total cost of care (Rich et al, 1995), particularly among the more severely ill (Wasson et al, 1992).…”

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confidence: 99%

Implementation of Guideline-Based Care for Depression in Primary Care

Rollman

Korsen

Schulberg

2005

Adm Policy Ment Health

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Evidence-based clinical practice guidelines for treating depression in primary care settings were developed, in part, to ensure that health services are provided in a consistent, highquality, and cost-effective manner. Yet for a variety of reasons, guideline-based primary care for depression remains the exception rather than the rule. This work provides a brief review of effective strategies used to customize and then deliver evidence-based treatment for depression in primary care settings; describes two representative case studies that illustrate locally customized collaborative care strategies for treatment delivery; and concludes with principles and implications for policy and practice based on our practical experiences.

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“…Studies show that around 15% of primary care patients screen positive for depression on brief instruments (19,20). Even with the new resources that may be created by recent mental health parity legislation (21), on the basis of numbers alone it is unrealistic to expect to refer all patients who screen positive to mental health specialists for a full evaluation and for treatment of major depression or related mood disorders, such as dysthymia.…”

Section: Discussionmentioning

confidence: 99%

Wishing Upon a STAR*D: The Promise of Ideal Depression Care by Primary Care Providers

Ong

Rubenstein²

2009

Psychiatric Services

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The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial found that after initial treatment, depressed patients treated in primary care settings had the same or slightly better outcomes than those treated in specialty care settings. The authors describe challenges to using the STAR*D approach and protocols in usual primary care settings. These include inadequate availability of appointments, insufficient resources for care management and treatment monitoring, and lack of payment to primary care providers for providing mental health care. Substantial reengineering of payment and delivery systems is needed in order for the STAR*D approach to be viable in primary care clinics.

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Impact of Disseminating Quality Improvement Programs for Depression in Managed Primary Care

Cited by 937 publications

References 37 publications

Depression and Cardiovascular Disease

Depression and Cardiovascular Disease

Implementation of Guideline-Based Care for Depression in Primary Care

Wishing Upon a STAR*D: The Promise of Ideal Depression Care by Primary Care Providers

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