Long-Term Clinical Outcomes of Care Management for Chronically Depressed Primary Care Patients

Chronically depressed patients in primary practices are helped by a program that uses a care manager intervention and teaches self-management techniques.

The Depression in Primary Care demonstration program funded by the Robert Wood Johnson Foundation sought to develop, implement and evaluate the effectiveness of a depression-management program in primary care practices over an 18-month period.

Care managers (registered nurses or individuals with a master’s in social work) assessed depression severity and complexity of patients referred to the program in five primary care practices. Five other practices were matched as control sites. The care managers assessed treatment adherence, functional impairment and satisfaction with care. Respondents completed questionnaires at baseline, six, 12 and 18 months. The care managers also designed and administered a curriculum to increase enrollee’s self-management of their depression. They provided feedback to referring physicians about clinical progress and possible complications.

This low-intensity, tailored care management program led to improvement in care for depression for chronically-depressed patients found in primary care practices. Using a variation of a well-validated patient health questionnaire (omitting an assessment for self-harm due to legal reasons), the care managers found that the patients enrolled in the program had significantly greater reduction in their depressive symptoms (mean score 4.17 points lower) than usual care patients (1.07 points lower). The program appeared highly acceptable to patients with 83 percent completing the 18-month program.