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| |  Care Management Reduces Depression, Suicidal Thoughts in Older Primary Care Patients NEW YORK -- June 24, 2009 -- Adding a trained depression care manager to primary care practices can increase the number of older patients receiving treatment, lead to a higher remission rate of depression, and reduce suicidal thoughts, according to a study published online in the American Journal of Psychiatry. George S. Alexopoulos, MD, Institute of Geriatric Psychiatry, NewYork-Presbyterian Hospital Westchester Division, and Weill Cornell Medical College, New York, New York, reported on the 2-year outcomes of the multicentre Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT) study. "Almost 1 in 10 older adults in the US has some form of depression, and one-fifth among them contemplates suicide. Two-thirds of these patients are treated by primary care physicians. Sadly, their depression is often inadequately treated due to the primary care physician's time constraints and the patient's reluctance to discuss their symptoms and adhere to treatment," said Dr. Alexopoulos. "The critical finding of the PROSPECT study is that adding a trained care manager to primary care practices increases the number of depressed older patients who receive treatment and improves their outcomes, not only in the short term, but over 2 years. "This is important because depression can either become chronic or relapse after an initial improvement," adds Dr. Alexopoulos. "Most diseases have worse outcomes when an old person becomes depressed. Depression almost doubles the risk for death. It follows that treating depression effectively can reduce sickness, disability and death." The study followed 599 patients aged 60 years and older with depression at 20 primary care practices of varying sizes in New York and Pennsylvania. Participants were randomised to receive either the PROSPECT intervention or usual care. Those in the PROSPECT group were assigned a care manager -- a trained social worker, nurse or psychologist -- who helped the physician offer treatment according to accepted practice guidelines, monitored treatment response, and provided follow-up over 2 years. Practice guidelines included the antidepressant citalopram , with the option of other drugs or psychotherapy. After 2 years, nearly 90% of patients in the PROSPECT care management group had received treatment for depression, compared with 62% of those receiving usual care by their physicians. The decline in suicidal ideation was 2.2 times greater in the PROSPECT group. Remission of depression happened faster in the PROSPECT intervention group and remission rates continued to increase between months 18 and 24, while no appreciable increase occurred in the usual care group during the same period. The PROSPECT intervention worked especially well for a subgroup of patients with major depression with a greater number achieving remission, or the near absence of symptoms. Patients with minor depression had favourable outcomes regardless of their study group. SOURCE: NewYork-Presbyterian Hospital/Westchester Division
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