Practice-Based Interventions Addressing Concomitant Depression and Chronic Medical Conditions in the Primary Care Setting: A Systematic Review and Meta-Analysis (original) (raw)
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Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2007
To review randomized controlled trials (RCTs) evaluating chronic disease management models for depression in primary care and to look at the implications for clinical practice in Canada. We reviewed all RCTs conducted between 1992 and 2006, including other reviews and analyses of pooled data. Using various search terms, we searched PsycINFO, Cinahl (1982 to May 2005), MEDLINE (1995 to 2005), EMBASE, The Cochrane Library, and PubMed. There is conclusive evidence for the benefits of changing systems of care delivery to support the more effective management of depression in primary care. Most studies have demonstrated improved outcomes in terms of symptom reduction, relapse prevention, functioning in the community, adherence to treatment, community and workplace involvement, and satisfaction with care received. Primary care practices need to examine how they can incorporate different concepts and models for managing depression. Components to consider include case registries, care manag...
Depression Treatment in Primary Care
Background: Depression costs the United States $40 billion annually. Primary care physicians play a key role in the identification and treatment of depression. This study focused on the treatment options recommended by physicians and whether physicians were following the recommended treatment guidelines.
2008
This review of psychological interventions for major depression in primary care concluded that brief treatments were more effective than GP-delivered usual care in reducing symptoms and may be equivalent to antidepressant therapy. Many aspects of this review were well-conducted, but due to a paucity of reporting in several areas the conclusions should not be regarded as reliable. Authors' objectives To evaluate the effectiveness of psychological interventions delivered in primary care settings for major depression, compared with usual general practitioner (GP) treatment or antidepressant drug treatment. Searching MEDLINE, EMBASE, PsycINFO and The Cochrane Library were searched from January 1995 to June 2006. Search terms were reported. The date restrictions were applied to improve the methodological quality of the retrieved studies. Only English-language papers were considered. Reference lists were checked and well-known experts were contacted for further studies.
Systematic review of multifaceted interventions to improve depression care
General Hospital Psychiatry, 2007
Recent epidemiologic studies have found that most patients with mental illness are seen exclusively in primary care medicine. These patients often present with medically unexplained somatic symptoms and utilize at least twice as many health care visits as controls. There has been an exponential growth in studies in this interface between primary care and psychiatry in the last 10 years. This special section, edited by Jü rgen Unutzer, M.D., will publish informative research articles that address primary care-psychiatric issues.
Evidence-based care for depression in managed primary care practices
Health Affairs, 1999
PROLOGUE: The gap between theory and practice in health care can be daunting. Researchers armed with massive amounts of outcomes data face the problem of translating their findings into workable interventions in the practice setting. This paper reports on an attempt to bridge the gap, taking advantage of the administrative capabilities of managed care organizations. The authors designed, implemented, and tracked a collaborative-care program of treatment for patients with symptoms of depression. The results presented here highlight the program's success in creating a "partnership between health care organizations and researchers." Lisa Rubenstein is a practicing geriatrician and internist at the University of California, Los Angeles (UCLA), School of Medicine and Veterans Administration Medical Center (VAMC), Sepulveda, California; a senior natural scientist at RAND; and director of the VA/RAND/UCLA Center for the Study of Healthcare Provider Behavior. Maga Jackson-Triche is director of the Psychiatry Consultation and Liaison Services at the Sepulveda VAMC, and the psychiatric administrator for the PACE (Primary Care and Education) program there. Jürgen Unützer is a geriatric psychiatrist and health services researcher at the UCLA Neuropsychiatric Institute (NPI). Jeanne Miranda, a psychologist, is an associate professor of psychiatry at Georgetown University Medical Center in Washington, D.C. Katy Minnium is a research associate in the department of psychiatry at UCLA. Marjorie Pearson is a health policy analyst at RAND. Ken Wells is professor-in-residence of psychiatry and biobehavioral sciences at UCLA-NPI and a senior scientist at RAND.
Managing Depression and Medical Comorbidities
Postgraduate Medicine, 2003
Caring for patients with depression who have comorbid medical conditions is a major challenge for primary care physicians. Depression is often difficult to diagnose in a primary care setting, and comorbidity vastly complicates diagnosis because of physiologic interactions and shared symptoms. Furthermore, physicians face the difficulty of developing a treatment plan that improves the outcome of multiple conditions at the same time. Fortunately, because of the recent development of effective and well-tolerated antidepressants, successful treatment and long-term management of depression are relatively straightforward and often greatly improve the status of the comorbid illness as well by improving overall function, treatment adherence, recovery rates, and survival time.
Issues in treating depression in primary care
Continuing Medical Education, 2013
The last 10 years have seen exciting developments in the availability of new evidence-based treatments for depression. This includes the registration of new antidepressants (ADs) as well as new information about the effectiveness of ADs and psychological therapies. Many 'alternative' therapies, including exercise, herbal remedies, green tea and massage therapies, are promoted for depression, but discussion of these is beyond the scope of this article. Most new literature and conference proceedings focus on new drugs and treatment-resistant depression, leaving little room for questioning some of the basic assumptions. Evidence-based methods of review and the global access to information through the internet have led to new questions and information about the treatment of depression.
BMC Family …, 2011
Background: Several systematic reviews have summarized the evidence for specific treatments of primary care atients suffering from depression. However, it is not possible to answer the question how the available treatment options compare with each other as review methods differ. We aim to systematically review and compare the vailable evidence for the effectiveness of pharmacological, psychological, and combined treatments for patients ith depressive disorders in primary care. Methods/Design: To be included, studies have to be randomized trials comparing antidepressant medication tricyclic ntidepressants, selective serotonin reuptake inhibitors (SSRIs), hypericum extracts, other agents) and/or psychological therapies (e.g. interpersonal psychotherapy, cognitive therapy, behavioural therapy, short dynamicallyoriented sychotherapy) with another active therapy, placebo or sham intervention, routine care or no treatment in primary care patients in the acute phase of a depressive episode. Main outcome measure is response after completion of acute phase treatment. Eligible studies will be identified from available systematic reviews, from searches in electronic databases (Medline, Embase and Central), trial registers, and citation tracking. Two reviewers will independently extract study data and assess the risk of bias using the Cochrane Collaboration’s corresponding tool. Meta-analyses (random effects model, inverse variance weighting) will be performed for direct comparisons of single interventions and for groups of similar interventions (e.g. SSRIs vs. tricyclics) and defined time-windows (up to 3 months and above). If possible, a global analysis of the relative effectiveness of treatments will be estimated from all available direct and indirect evidence that is present in a network of treatments and comparisons. Discussion: Practitioners do not only want to know whether there is evidence that a specific treatment is more effective than placebo, but also how the treatment options compare to each other. Therefore, we believe that a multiple treatment systematic review of primary-care based randomized controlled trials on the most important. therapies against depression is timely.