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Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care.

Publication ,  Journal Article
Hunkeler, EM; Katon, W; Tang, L; Williams, JW; Kroenke, K; Lin, EHB; Harpole, LH; Arean, P; Levine, S; Grypma, LM; Hargreaves, WA; Unützer, J
Published in: BMJ
February 4, 2006

OBJECTIVE: To determine the long term effectiveness of collaborative care management for depression in late life. DESIGN: Two arm, randomised, clinical trial; intervention one year and follow-up two years. SETTING: 18 primary care clinics in eight US healthcare organisations. Patients 1801 primary care patients aged 60 and older with major depression, dysthymia, or both. INTERVENTION: Patients were randomly assigned to a 12 month collaborative care intervention (IMPACT) or usual care for depression. Teams including a depression care manager, primary care doctor, and psychiatrist offered education, behavioural activation, antidepressants, a brief, behaviour based psychotherapy (problem solving treatment), and relapse prevention geared to each patient's needs and preferences. MAIN OUTCOME MEASURES: Interviewers, blinded to treatment assignment, conducted interviews in person at baseline and by telephone at each subsequent follow up. They measured depression (SCL-20), overall functional impairment and quality of life (SF-12), physical functioning (PCS-12), depression treatment, and satisfaction with care. RESULTS: IMPACT patients fared significantly (P < 0.05) better than controls regarding continuation of antidepressant treatment, depressive symptoms, remission of depression, physical functioning, quality of life, self efficacy, and satisfaction with care at 18 and 24 months. One year after IMPACT resources were withdrawn, a significant difference in SCL-20 scores (0.23, P < 0.0001) favouring IMPACT patients remained. CONCLUSIONS: Tailored collaborative care actively engages older adults in treatment for depression and delivers substantial and persistent long term benefits. Benefits include less depression, better physical functioning, and an enhanced quality of life. The IMPACT model may show the way to less depression and healthier lives for older adults.

Duke Scholars

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Published In

BMJ

DOI

EISSN

1756-1833

Publication Date

February 4, 2006

Volume

332

Issue

7536

Start / End Page

259 / 263

Location

England

Related Subject Headings

  • Treatment Outcome
  • Secondary Prevention
  • Psychotherapy
  • Primary Health Care
  • Patient Satisfaction
  • Middle Aged
  • Male
  • Humans
  • General & Internal Medicine
  • Follow-Up Studies
 

Citation

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Hunkeler, E. M., Katon, W., Tang, L., Williams, J. W., Kroenke, K., Lin, E. H. B., … Unützer, J. (2006). Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care. BMJ, 332(7536), 259–263. https://doi.org/10.1136/bmj.38683.710255.BE
Hunkeler, Enid M., Wayne Katon, Lingqi Tang, John W. Williams, Kurt Kroenke, Elizabeth H. B. Lin, Linda H. Harpole, et al. “Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care.BMJ 332, no. 7536 (February 4, 2006): 259–63. https://doi.org/10.1136/bmj.38683.710255.BE.
Hunkeler EM, Katon W, Tang L, Williams JW, Kroenke K, Lin EHB, et al. Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care. BMJ. 2006 Feb 4;332(7536):259–63.
Hunkeler, Enid M., et al. “Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care.BMJ, vol. 332, no. 7536, Feb. 2006, pp. 259–63. Pubmed, doi:10.1136/bmj.38683.710255.BE.
Hunkeler EM, Katon W, Tang L, Williams JW, Kroenke K, Lin EHB, Harpole LH, Arean P, Levine S, Grypma LM, Hargreaves WA, Unützer J. Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care. BMJ. 2006 Feb 4;332(7536):259–263.

Published In

BMJ

DOI

EISSN

1756-1833

Publication Date

February 4, 2006

Volume

332

Issue

7536

Start / End Page

259 / 263

Location

England

Related Subject Headings

  • Treatment Outcome
  • Secondary Prevention
  • Psychotherapy
  • Primary Health Care
  • Patient Satisfaction
  • Middle Aged
  • Male
  • Humans
  • General & Internal Medicine
  • Follow-Up Studies