Utilization of antidepressant medications among elderly patients with depression: Comparison between usual care and collaborative care using care managers

2013 ◽  
Vol 21 (3) ◽  
pp. S130
Author(s):  
Ramona DeJesus
Keyword(s):  
Elderly Patients ◽  
Usual Care ◽  
Collaborative Care ◽  
Antidepressant Medications ◽  
Care Managers

scholarly journals Antidepressant Medication Use Among Patients with Depression: Comparison between Usual Care and Collaborative Care Using Care Managers

2013 ◽  
Vol 9 (1) ◽  
pp. 84-87 ◽  
Author(s):  
Ramona S DeJesus ◽  
Kurt B Angstman ◽  
Stephen S Cha ◽  
Mark D Williams
Keyword(s):  
Primary Care ◽  
Usual Care ◽  
Collaborative Care ◽  
Antidepressant Medication ◽  
Primary Care Clinics ◽  
Primary Care Settings ◽  
Care Managers ◽  
Significant Difference ◽  
Depression Management ◽  
Treatment Improvement

Depression poses a significant economic and health burden, yet it remains underdiagnosed and inadequately treated. The STAR*D trial funded by the National Institute of Mental Health showed that more than one antidepressant medication is often necessary to achieve disease remission among patients seen in both psychiatric and primary care settings. The collaborative care model (CCM), using care managers, has been shown to be effective in numerous studies in achieving sustained outcomes in depression management compared to usual care. This model was adopted in a statewide depression treatment improvement initiative among primary care clinics in Minnesota, which was launched in March 2008. In this study, records of patients who were enrolled in CCM from March 2008 until March 2009 were reviewed and compared to those under usual care. Patients who were followed under the CCM had a significantly greater number of antidepressant medication utilizations when compared to those under usual care. After 6 months, mean PHQ-9 score of patients under CCM was statistically lower than those in usual care. There was no significant difference in both mean PHQ-9 scores at 6 months and antidepressant utilization between the 2 groups among patients aged 65 years and older.

Cost-effectiveness of nurse-based case management versus usual care for elderly patients with myocardial infarction: results from the KORINNA study

2014 ◽  
Vol 16 (6) ◽  
pp. 671-681 ◽  
Author(s):  
Hildegard Seidl ◽  
Matthias Hunger ◽  
Reiner Leidl ◽  
Christa Meisinger ◽  
Rupert Wende ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cost Effectiveness ◽  
Elderly Patients ◽  
Case Management ◽  
Usual Care

scholarly journals The 3-Year Cost-Effectiveness of a Nurse-Based Case Management versus Usual Care for Elderly Patients with Myocardial Infarction: Results from the KORINNA Follow-Up Study

2017 ◽  
Vol 20 (3) ◽  
pp. 441-450 ◽  
Author(s):  
Hildegard Seidl ◽  
Matthias Hunger ◽  
Christa Meisinger ◽  
Inge Kirchberger ◽  
Bernhard Kuch ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cost Effectiveness ◽  
Elderly Patients ◽  
Case Management ◽  
Usual Care ◽  
Follow Up Study

Perioperative Multicomponent Interdisciplinary Program Reduces Delirium Incidence in Elderly Patients With Hip Fracture

2020 ◽  
pp. 107839032091525
Author(s):  
Xin Zhao ◽  
Wei Yuan
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Usual Care ◽  
Usual Care Group ◽  
Postoperative Delirium ◽  
Care Group ◽  
Interdisciplinary Program ◽  
Study Results ◽  
Experimental Group ◽  
Interdisciplinary Intervention

BACKGROUND: Delirium is common in elderly patients with hip fracture. Although several multicomponent care pathways have been developed, few nurse-led perioperative multicomponent programs have been evaluated. OBJECTIVES: The current study aimed to evaluate the effect of a nurse-led perioperative multicomponent interdisciplinary program in preventing postoperative delirium in elderly patients with hip fracture. METHOD: The participants in the usual care group were recruited from March 2012 to February 2013, and these in the experimental group were recruited from May 2013 to June 2014. The participants in the usual care group ( n = 174) received usual medical and nursing care from admission to hospital discharge and the participants in the experimental group ( n = 192) received the nurse-led perioperative multicomponent interdisciplinary intervention. The STROBE checklist was used to report this study. RESULTS: There were no statistical differences between the two cohorts in terms of the baseline data such as gender, age, fracture type, and so on. The experimental group had a lower incidence of delirium and postoperative hypoxia than the usual care group. No statistical differences in terms of delirium severity, delirium duration, and mean hospitalization length were observed. CONCLUSIONS: The nurse-led perioperative multicomponent interdisciplinary program described in the current study is feasible and effective in reducing the incidence of postoperative delirium in elderly patients with hip fracture.

scholarly journals Implementation of care managers for patients with depression: a cross-sectional study in Swedish primary care

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e035629
Author(s):  
Pia Augustsson ◽  
Anna Holst ◽  
Irene Svenningsson ◽  
Eva-Lisa Petersson ◽  
Cecilia Björkelund ◽  
...  
Keyword(s):  
Primary Care ◽  
Collaborative Care ◽  
Qualitative Content Analysis ◽  
Controlled Trial ◽  
Cross Sectional Study ◽  
Healthcare Management ◽  
Sectional Study ◽  
Cross Sectional ◽  
Care Manager ◽  
Care Managers

ObjectivesTo perform an analysis of collaborative care with a care manager implementation in a primary healthcare setting. The study has a twofold aim: (1) to examine clinicians’ and directors’ perceptions of implementing collaborative care with a care manager for patients with depression at the primary care centre (PCC), and (2) to identify barriers and facilitators that influenced this implementation.DesignA cross-sectional study was performed in 2016–2017 in parallel with a cluster-randomised controlled trial.Setting36 PCCs in south-west Sweden.ParticipantsPCCs’ directors and clinicians.OutcomeData regarding the study’s aims were collected by two web-based questionnaires (directors, clinicians). Descriptive statistics and qualitative content analysis were used for analysis.ResultsAmong the 36 PCCs, 461 (59%) clinicians and 36 (100%) directors participated. Fifty-two per cent of clinicians could cooperate with the care manager without problems. Forty per cent regarded to their knowledge of the care manager assignment as insufficient. Around two-thirds perceived that collaborating with the care manager was part of their duty as PCC staff. Almost 90% of the PCCs’ directors considered that the assignment of the care manager was clearly designed, around 70% considered the priority of the implementation to be high and around 90% were positive to the implementation. Facilitators consisted of support from colleagues and directors, cooperative skills and positive attitudes. Barriers were high workload, shortage of staff and extensive requirements and demands from healthcare management.ConclusionsOur study confirms that the care manager puts collaborative care into practice. Facilitators and barriers of the implementation, such as time, information, soft values and attitudes, financial structure need to be considered when implementing care managers at PCCs.

scholarly journals A Remote Collaborative Care Program for Patients with Depression Living in Rural Areas: Open-Label Trial (Preprint)

2017 ◽  
Author(s):  
Graciela Rojas ◽  
Viviana Guajardo ◽  
Pablo Martínez ◽  
Ariel Castro ◽  
Rosemarie Fritsch ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Usual Care ◽  
Collaborative Care ◽  
Rural Areas ◽  
Care Program ◽  
Open Label ◽  
Rural Primary Care ◽  
Primary Care Teams ◽  
Clinical Records

BACKGROUND In the treatment of depression, primary care teams have an essential role, but they are most effective when inserted into a collaborative care model for disease management. In rural areas, the shortage of specialized mental health resources may hamper management of depressed patients. OBJECTIVE The aim was to test the feasibility, acceptability, and effectiveness of a remote collaborative care program for patients with depression living in rural areas. METHODS In a nonrandomized, open-label (blinded outcome assessor), two-arm clinical trial, physicians from 15 rural community hospitals recruited 250 patients aged 18 to 70 years with a major depressive episode (DSM-IV criteria). Patients were assigned to the remote collaborative care program (n=111) or to usual care (n=139). The remote collaborative care program used Web-based shared clinical records between rural primary care teams and a specialized/centralized mental health team, telephone monitoring of patients, and remote supervision by psychiatrists through the Web-based shared clinical records and/or telephone. Depressive symptoms, health-related quality of life, service use, and patient satisfaction were measured 3 and 6 months after baseline assessment. RESULTS Six-month follow-up assessments were completed by 84.4% (221/250) of patients. The remote collaborative care program achieved higher user satisfaction (odds ratio [OR] 1.94, 95% CI 1.25-3.00) and better treatment adherence rates (OR 1.81, 95% CI 1.02-3.19) at 6 months compared to usual care. There were no statically significant differences in depressive symptoms between the remote collaborative care program and usual care. Significant differences between groups in favor of remote collaborative care program were observed at 3 months for mental health-related quality of life (beta 3.11, 95% CI 0.19-6.02). CONCLUSIONS Higher rates of treatment adherence in the remote collaborative care program suggest that technology-assisted interventions may help rural primary care teams in the management of depressive patients. Future cost-effectiveness studies are needed. CLINICALTRIAL Clinicaltrials.gov NCT02200367; https://clinicaltrials.gov/ct2/show/NCT02200367 (Archived by WebCite at http://www.webcitation.org/6xtZ7OijZ)

scholarly journals The impact of medication reviews conducted in primary care on hospital admissions and mortality - a randomized controlled trial

2019 ◽  
Author(s):  
Veronica Milos Nymberg ◽  
Cecilia Lenander ◽  
Beata Borgström Bolmsjö
Keyword(s):  
Primary Care ◽  
Elderly Patients ◽  
Usual Care ◽  
Frail Elderly ◽  
Hospital Admissions ◽  
Intervention Group ◽  
Control Group ◽  
Randomized Controlled ◽  
Medication Reviews ◽  
The Impact

Abstract Background Drug-related problems among the elderly population are common and increasing. Multi-professional medication reviews (MR) have arisen as a method to optimize drug therapy for frail elderly patients. Research has not yet been able to show conclusive evidence of the effect of MRs on mortality or hospital admissions. Aim The aim of this study was to assess the impact of MRs’ on hospital admissions and mortality after six and 12 months in a frail population of 369 patients in primary care in a randomized controlled study. Methods Patients were blindly randomized to an intervention group (receiving MRs) and a control group (receiving usual care). Descriptive data on mortality and hospital admissions at six and 12 months were collected. Survival analysis was performed for time to death and time to the first hospital admission within 12 months. Results Of the total number of 369 included patients, 182 were randomized to the intervention group and 187 to the control group. Most of the patients (75%) were females and lived in nursing homes. At six months, 50 patients of the baseline population (27%) in the control group had been admitted to hospital at least once, compared to 40 patients (21%) in the intervention group. At 12 months, the percentage had increased to 70 (37%) in the control group compared to 53 (29%) in the intervention group. Compared to usual care, we found that MRs reduced the risk of hospital admissions within 12 months by 36% (HR = 0.64, 95% CI 0.45-0.90), but found no difference on mortality (HR = 1.12, 95% CI 0.78-1.61) between the groups. Conclusion We suggest that MRs should be recommended in the care of frail elderly patients with expected benefits on hospital admissions.

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