Email reminders as a self-management tool in depression: a needs assessment to determine patients' interests and preferences.

We conducted a needs assessment to ascertain patients' interests and preferences for using email reminders ('E-minders') to assist in the self-management of their depression. The E-minders would help patients achieve remission by reminding them of their personal strategies for self-management and their personalized sources of support. Once patients had achieved remission, E-minders would be used to remind them of their original symptoms of depression so that they could monitor for recurrence. Results from a focus group with eight patients suggested that patients would be interested in using E-minders. However, they should not be used to replace aspects of treatment but rather to supplement existing depression treatment regimens.

Long-term clinical outcomes of care management for chronically depressed primary care patients: a report from the depression in primary care project.

PURPOSE: Recent studies examining depression disease management report improvements in short-term outcomes, but less is known about whether improvements are sustainable over time. This study evaluated the sustained clinical effectiveness of low-intensity depression disease management in chronically depressed patients. METHODS: The Depression in Primary Care (DPC) intervention was introduced in 5 primary care practices in the University of Michigan Health System, with 5 matched practices selected as control sites. Clinicians were free to refer none, some, or all of their depressed patients at their discretion. Core clinical outcomes of remission and serial change in Patient Health Questionnaire (PHQ-8) scores for 728 DPC enrollees observed for up to 18 months after enrollment were compared with those for 78 patients receiving usual care who completed mailed questionnaires at baseline, 6, 12, and 18 months. RESULTS: DPC enrollees had sustained improvement in remission rates and reduced-function days over the full 18 months. Mean change in the PHQ-8 score over each 6-month interval was more favorable for DPC enrollees than for usual care patients, and the proportion of DPC enrollees in remission was higher at 6 months (43.4% vs 33.3%; P = .11), 12 months (52.0% vs 33.9%; P = .012), and 18 months (49.2% vs 27.3%; P = .004). Multivariate analysis controlling for age, sex, ethnicity, baseline severity, and comorbid medical illness confirmed that DPC enrollees had significantly more reduction in depressive symptom burden over 18 months. CONCLUSIONS: The DPC intervention produced sustained improvement in clinical outcomes over 18 months in a cohort of chronically depressed patients with persistent symptoms despite active treatment.

Effectiveness of a depression disease management program in improving depression and work function--a pilot study.

OBJECTIVE: We examined whether there were differences in depression and work function outcomes among primary care and specialty mental health patients treated by the Michigan Depression Outreach and Collaborative Care (M-DOCC), a depression care management program, developed by the University of Michigan Depression Center. In addition, we examined the relationship between depressive symptoms and workplace functioning among M-DOCC enrollees over time. METHOD: We used mixed model and logistic regression analyses. RESULTS: Despite baseline differences in patient characteristics between primary care and specialty care patients, the location of treatment setting was not a significant predictor of depression or work function outcomes over time among patients enrolled in a depression care management program. Patients in both treatment settings showed significant decreases in depressive and functional impairment over time, with improvements in these symptoms occurring concurrently. Patients with greater case severity were less likely to demonstrate depression and work function improvements over time, and more severe side effects were associated with fewer depression symptom improvements over time. CONCLUSIONS: Both depression and work function outcomes improved over time among patients enrolled in a depression care management program, and this improvement did not differ based on whether a patient was treated in a primary or specialty care setting.

Challenges of implementing depression care management in the primary care setting.

Empirical evidence shows that care management is an effective tool for improving depression treatment in primary care patients. However, several conceptual and practical issues have not been sufficiently addressed. This article explores questions concerning the scope of care management services within the chronic illness care model; optimal ways to identify depressed patients in the primary care setting; responsibilities and desirable qualifications of depression care managers; the location and manner in which care managers interact with patients; costs of services provided by care managers; and the level of supervision by mental health specialists that is necessary to ensure quality care.