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Improving primary care for depression in late life: the design of a multicenter randomized trial.

Publication ,  Journal Article
Unützer, J; Katon, W; Williams, JW; Callahan, CM; Harpole, L; Hunkeler, EM; Hoffing, M; Arean, P; Hegel, MT; Schoenbaum, M; Oishi, SM; Langston, CA
Published in: Med Care
August 2001

BACKGROUND: Late life depression can be successfully treated with antidepressant medications or psychotherapy, but few depressed older adults receive effective treatment. RESEARCH DESIGN: A randomized controlled trial of a disease management program for late life depression. SUBJECTS: Approximately 1,750 older adults with major depression or dysthymia are recruited from seven national study sites. INTERVENTION: Half of the subjects are randomly assigned to a collaborative care program where a depression clinical specialist supervised by a psychiatrist and a primary care expert supports the patient's regular primary care provider to treat depression. Intervention services are provided for 12 months using antidepressant medications and Problem Solving Treatment in Primary Care according to a stepped care protocol that varies intervention intensity according to clinical needs. The other half of the subjects are assigned to care as usual. EVALUATION: Subjects are independently assessed at baseline, 3 months, 6 months, 12 months, 18 months, and 24 months. The evaluation assesses the incremental cost-effectiveness of the intervention compared with care as usual. Specific outcomes examined include care for depression, depressive symptoms, health-related quality of life, satisfaction with depression care, health care costs, patient time costs, market and nonmarket productivity, and household income. CONCLUSIONS: The study blends methods from health services and clinical research in an effort to protect internal validity while maximizing the generalizability of results to diverse health care systems. We hope that this study will show the cost-effectiveness of a new model of care for late life depression that can be applied in a range of primary care settings.

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Published In

Med Care

DOI

ISSN

0025-7079

Publication Date

August 2001

Volume

39

Issue

8

Start / End Page

785 / 799

Location

United States

Related Subject Headings

  • United States
  • Software Design
  • Primary Health Care
  • Patient Education as Topic
  • Patient Care Team
  • Outcome Assessment, Health Care
  • Male
  • Inservice Training
  • Humans
  • Health Services for the Aged
 

Citation

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Unützer, J., Katon, W., Williams, J. W., Callahan, C. M., Harpole, L., Hunkeler, E. M., … Langston, C. A. (2001). Improving primary care for depression in late life: the design of a multicenter randomized trial. Med Care, 39(8), 785–799. https://doi.org/10.1097/00005650-200108000-00005
Unützer, J., W. Katon, J. W. Williams, C. M. Callahan, L. Harpole, E. M. Hunkeler, M. Hoffing, et al. “Improving primary care for depression in late life: the design of a multicenter randomized trial.Med Care 39, no. 8 (August 2001): 785–99. https://doi.org/10.1097/00005650-200108000-00005.
Unützer J, Katon W, Williams JW, Callahan CM, Harpole L, Hunkeler EM, et al. Improving primary care for depression in late life: the design of a multicenter randomized trial. Med Care. 2001 Aug;39(8):785–99.
Unützer, J., et al. “Improving primary care for depression in late life: the design of a multicenter randomized trial.Med Care, vol. 39, no. 8, Aug. 2001, pp. 785–99. Pubmed, doi:10.1097/00005650-200108000-00005.
Unützer J, Katon W, Williams JW, Callahan CM, Harpole L, Hunkeler EM, Hoffing M, Arean P, Hegel MT, Schoenbaum M, Oishi SM, Langston CA. Improving primary care for depression in late life: the design of a multicenter randomized trial. Med Care. 2001 Aug;39(8):785–799.

Published In

Med Care

DOI

ISSN

0025-7079

Publication Date

August 2001

Volume

39

Issue

8

Start / End Page

785 / 799

Location

United States

Related Subject Headings

  • United States
  • Software Design
  • Primary Health Care
  • Patient Education as Topic
  • Patient Care Team
  • Outcome Assessment, Health Care
  • Male
  • Inservice Training
  • Humans
  • Health Services for the Aged