LOS ANGELES – A collaborative-care model for depression management resulted in significantly greater reductions in depression scores and treatment response, compared with usual care, among 186 older adults included in a records review.
After 6 months of treatment, the mean score on the nine-item depression scale of the Patient Health Questionnaire (PHQ-9) was significantly lower for 93 patients enrolled in the collaborative-care model than for 93 patients who received usual care (6.42 vs. 13.19). The mean improvement in PHQ-9 score from baseline also was significantly greater in the collaborative-care group, Dr. Ramona DeJesus reported in a poster at the annual meeting of the American Association for Geriatric Psychiatry.
Antidepressant medication use was similar in the two groups at 6 months, said Dr. DeJesus, an internist and assistant professor of medicine at the Mayo Clinic in Rochester, Minn.
Collaborative-care models that bring primary care providers and psychiatrists together to care for patients have been shown in numerous studies to be more effective than usual care for the management of depression. One such model – Depression Improvement Across Minnesota, Offering a New Direction (DIAMOND) – was implemented in March 2008 at primary care sites at the Mayo Clinic.
The DIAMOND program, which was developed by the Institute for Clinical Systems Improvement, provides for consistent patient assessment, a registry that tracks treatment response over time, and a focus on relapse prevention. The model involves a primary care manager and a liaison or consultative relationship with a psychiatrist, Dr. DeJesus explained in an interview.
In a prior study, she found that patients treated using the collaborative-care model had significantly greater use of antidepressant medications after 1 year, compared with those receiving usual care, but a subgroup analysis of those over age 65 years in that study did not yield similar results.
For the current study, medical records of patients aged 65 years and older who had received a diagnosis of depression between March 2008, when the DIAMOND program was implemented, and December 2010 were reviewed. All had a screening score of 10 or greater on the PHQ-9. The collaborative-care and usual-care patient groups were similar with respect to demographic characteristics, including age, gender, race, ethnicity, marital status, and baseline PHQ-9 score.
As in the earlier trial, these findings show that antidepressant use is not increased among older adults treated using a collaborative-care model. This might be a result of increased caution with respect to prescribing in older adults, Dr. DeJesus said.
"The collaborative-care model consistently demonstrates efficacy across both young and elderly populations," she said, noting that the current findings provide further support for use of this model in the elderly population.
Dr. DeJesus reported having no disclosures.