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Long term effect of depression care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care

Objective To investigate whether an intervention to improve treatment of depression in older adults in primary care modified the increased risk of death associated with depression. Design Long term follow-up of multi-site practice randomized controlled trial (PROSPECT—Prevention of Suicide in Primar...

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Autores principales: Gallo, Joseph J, Morales, Knashawn H, Bogner, Hillary R, Raue, Patrick J, Zee, Jarcy, Bruce, Martha L, Reynolds, Charles F
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group Ltd. 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673762/
https://www.ncbi.nlm.nih.gov/pubmed/23738992
http://dx.doi.org/10.1136/bmj.f2570
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author Gallo, Joseph J
Morales, Knashawn H
Bogner, Hillary R
Raue, Patrick J
Zee, Jarcy
Bruce, Martha L
Reynolds, Charles F
author_facet Gallo, Joseph J
Morales, Knashawn H
Bogner, Hillary R
Raue, Patrick J
Zee, Jarcy
Bruce, Martha L
Reynolds, Charles F
author_sort Gallo, Joseph J
collection PubMed
description Objective To investigate whether an intervention to improve treatment of depression in older adults in primary care modified the increased risk of death associated with depression. Design Long term follow-up of multi-site practice randomized controlled trial (PROSPECT—Prevention of Suicide in Primary Care Elderly: Collaborative Trial). Setting 20 primary care practices in New York City, Philadelphia, and Pittsburgh, USA, randomized to intervention or usual care. Participants 1226 participants identified between May 1999 and August 2001 through a two stage, age stratified (60-74; ≥75 years) depression screening of randomly sampled patients; enrollment included patients who screened positive and a random sample of patients who screened negative. Intervention For two years, a depression care manager worked with primary care physicians in intervention practices to provide algorithm based care for depression, offering psychotherapy, increasing antidepressant dose if indicated, and monitoring symptoms, adverse effects of drugs, and adherence to treatment. This paper reports the long term follow-up. Main outcome measure Mortality risk based on a median follow-up of 98 (range 0.8-116.4) months through 2008. Results In baseline clinical interviews, 396 people were classified as having major depression, 203 had clinically significant minor depression, and 627 did not meet criteria for depression. At follow-up, 405 patients had died. Patients with major depression in usual care were more likely to die than were those without depression (hazard ratio 1.90, 95% confidence interval 1.57 to 2.31). In contrast, patients with major depression in intervention practices were at no greater risk than were people without depression (hazard ratio 1.09, 0.83 to 1.44). Patients with major depression in intervention practices, relative to usual care, were 24% less likely to have died (hazard ratio 0.76, 0.57 to 1.00; P=0.05). Preliminary data on cause of death are provided. No significant effect on mortality was found for minor depression. Conclusions Older adults with major depression in practices provided with additional resources to intensively manage depression had a mortality risk lower than that observed in usual care and similar to older adults without depression. Trial registration Clinical trials NCT00000367.
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spelling pubmed-36737622013-06-06 Long term effect of depression care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care Gallo, Joseph J Morales, Knashawn H Bogner, Hillary R Raue, Patrick J Zee, Jarcy Bruce, Martha L Reynolds, Charles F BMJ Research Objective To investigate whether an intervention to improve treatment of depression in older adults in primary care modified the increased risk of death associated with depression. Design Long term follow-up of multi-site practice randomized controlled trial (PROSPECT—Prevention of Suicide in Primary Care Elderly: Collaborative Trial). Setting 20 primary care practices in New York City, Philadelphia, and Pittsburgh, USA, randomized to intervention or usual care. Participants 1226 participants identified between May 1999 and August 2001 through a two stage, age stratified (60-74; ≥75 years) depression screening of randomly sampled patients; enrollment included patients who screened positive and a random sample of patients who screened negative. Intervention For two years, a depression care manager worked with primary care physicians in intervention practices to provide algorithm based care for depression, offering psychotherapy, increasing antidepressant dose if indicated, and monitoring symptoms, adverse effects of drugs, and adherence to treatment. This paper reports the long term follow-up. Main outcome measure Mortality risk based on a median follow-up of 98 (range 0.8-116.4) months through 2008. Results In baseline clinical interviews, 396 people were classified as having major depression, 203 had clinically significant minor depression, and 627 did not meet criteria for depression. At follow-up, 405 patients had died. Patients with major depression in usual care were more likely to die than were those without depression (hazard ratio 1.90, 95% confidence interval 1.57 to 2.31). In contrast, patients with major depression in intervention practices were at no greater risk than were people without depression (hazard ratio 1.09, 0.83 to 1.44). Patients with major depression in intervention practices, relative to usual care, were 24% less likely to have died (hazard ratio 0.76, 0.57 to 1.00; P=0.05). Preliminary data on cause of death are provided. No significant effect on mortality was found for minor depression. Conclusions Older adults with major depression in practices provided with additional resources to intensively manage depression had a mortality risk lower than that observed in usual care and similar to older adults without depression. Trial registration Clinical trials NCT00000367. BMJ Publishing Group Ltd. 2013-06-05 /pmc/articles/PMC3673762/ /pubmed/23738992 http://dx.doi.org/10.1136/bmj.f2570 Text en © Gallo et al 2013 http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/.
spellingShingle Research
Gallo, Joseph J
Morales, Knashawn H
Bogner, Hillary R
Raue, Patrick J
Zee, Jarcy
Bruce, Martha L
Reynolds, Charles F
Long term effect of depression care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care
title Long term effect of depression care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care
title_full Long term effect of depression care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care
title_fullStr Long term effect of depression care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care
title_full_unstemmed Long term effect of depression care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care
title_short Long term effect of depression care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care
title_sort long term effect of depression care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673762/
https://www.ncbi.nlm.nih.gov/pubmed/23738992
http://dx.doi.org/10.1136/bmj.f2570
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