Three months after enrolling in a disease management program offered by telephone,
patients with acute depression were six times more likely to have their symptoms
reduced to a low level than those who received the standard care of diagnosis
and education about their condition.
Primary care doctors participating in the program were also more apt to use
nationally approved guidelines in treating their patients, say David W. Oslin,
M.D., of the University of Pennsylvania and colleagues.
Patients in the program who needed changes to their therapy during the follow-up
treatment period were seven times more likely to get care in line with guidelines
for depression therapy established by the Agency for Health Research and Quality,
according to the researchers.
Treatment provided through the phone program included many more opportunities
for feedback and monitoring of patients as they continued with their care — a
strategy that had been tested previously in face-to-face follow-up treatments.
The new findings “suggest that beneficial results are possible when
delivering disease management exclusively by telephone,” Oslin says
in the May issue of General Hospital Psychiatry.
Phone contact between the patients and specially trained nurses was used
to support the primary care doctor in treating acute depression. The nurses
monitored
symptoms and treatment outcomes at three-week intervals, reporting the results
back to each patient’s primary care doctor.
Although doctors were more likely to prescribe guideline-recommended care
for their patients in the phone program, the patients themselves were not
any more likely to follow their doctor’s orders than patients receiving
standard care, according to the researchers.
“If we can identify significant patient characteristics that predict
non-adherence, then an intervention or educational program could be directed
to these patients in order to improve their engagement in the management of
their depression,” Oslin says.
Oslin and colleagues hope that the phone program will help primary care doctors
treat more patients with depression, by making it easier to schedule follow-up
visits and allowing several clinics to share the costs of specialists trained
in depression disease management.
“Depression in primary care is a pressing public health problem. More
depressed patients of all ages are seen by primary care clinicians than by
specialty mental health providers,” Oslin says.
The study was supported by the University of Pennsylvania Health System and
the National Institute of Mental Health.
