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Titolo:
Randomized trial of case-finding for depression in elderly primary care patients
Autore:
Whooley, MA; Stone, B; Soghikian, K;
Indirizzi:
Dept Vet Affairs Med Ctr, Sect Gen Internal Med 111A1, San Francisco, CA 94121 USA Dept Vet Affairs Med Ctr San Francisco CA USA 94121 ancisco, CA 94121 USA
Titolo Testata:
JOURNAL OF GENERAL INTERNAL MEDICINE
fascicolo: 5, volume: 15, anno: 2000,
pagine: 293 - 300
SICI:
0884-8734(200005)15:5<293:RTOCFD>2.0.ZU;2-K
Fonte:
ISI
Lingua:
ENG
Soggetto:
LATE-LIFE DEPRESSION; ANTIDEPRESSANT TREATMENT; CONSENSUS STATEMENT; CAGE QUESTIONNAIRE; MINOR DEPRESSION; GENERAL-PRACTICE; OUTCOMES; DISORDERS; SYMPTOMS; ASSOCIATION;
Keywords:
depression; primary health care; randomized controlled trials; elderly;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
49
Recensione:
Indirizzi per estratti:
Indirizzo: Whooley, MA Dept Vet Affairs Med Ctr, Sect Gen Internal Med 111A1, 4150 Clement St, San Francisco, CA 94121 USA Dept Vet Affairs Med Ctr 4150 ClementSt San Francisco CA USA 94121
Citazione:
M.A. Whooley et al., "Randomized trial of case-finding for depression in elderly primary care patients", J GEN INT M, 15(5), 2000, pp. 293-300

Abstract

OBJECTIVE: To determine the effect of case-finding for depression on frequency of depression diagnoses, prescriptions for antidepressant medications,prevalence of depression, and health care utilization during 2 years of follow-up in elderly primary care patients. DESIGN: Randomized controlled trial. SETTING: Thirteen primary care medical clinics at the Raiser Permanente Medical Center, an HMO in Oakland, Calif, were randomly assigned to intervention conditions (7 clinics) or control conditions (6 clinics). PARTICIPANTS: A total of 2,346 patients aged 65 years or older who were attending appointments at these clinics and completed the 15-item Geriatric Depression Scale (GDS). GDS scores of 6 or more ware considered suggestive of depression. INTERVENTIONS: Primary care physicians in the intervention clinics were notified of their patients' GDS scores. We suggested that participants with severe depressive symptoms (GDS score greater than or equal to 11) be referred to the Psychiatry Department and participants with mild to moderate depressive symptoms (GDS score of 6-10) be evaluated and treated by the primarycare physician. Intervention group participants with GDS scores suggestiveof depression were also offered a series of organized educational group sessions on coping with depression led by a psychiatric nurse. Primary care physicians in the control clinics were not notified of their patients' GDS scores or advised of the availability of the patient education program (usual care). Participants were followed for 2 years. MEASUREMENTS AND MAIN RESULTS: Physician diagnosis of depression, prescriptions for antidepressant medications, prevalence of depression as measured by the GDS at 2-year follow-up, and health care utilization were determined. A total of 331 participants (14%) had GDS scores suggestive of depression(GDS greater than or equal to 6) at baseline, including 162 in the intervention group and 169 in the control group. During the 2-year follow-up period, 56 (35%) of the intervention participants and 58 (34%) of the control participants received a physician diagnosis of depression (odds ratio [OR], 1.0; 95% confidence interval [CI], 0.6 to 1.6; P = .96). Prescriptions for antidepressants were received by 59 (36%) of the intervention participants and 72 (43%) of the control participants (OR, 0.8; 95% CI, 0.5 to 1.2; P = .3). Two-year follow-up GDS scores were available for 206 participants (69% of survivors): at that time, 41 (42%) of the 97 intervention participants and 54 (50%) of the 109 control participants had GDS scores suggestive of depression (OR, 0.7; 95% CI, 0.4 to 1.3; P = .3). Comparing participants in the intervention and control groups, there were no significant differences in mean GDS change scores (-2.4 +/- SD 3.7 vs -2.1 SD +/- 3.6; P = .5) at the 2-year follow-up, nor were there significant differences in mean number of clinic visits (1.8 +/- SD 3.1 vs 1.6 +/- SD 2.8; P = .5) or mean number of hospitalizations (1.1 +/- SD 1.6 vs 1.0 +/- SD 1.4; P = .8) during the 2-year period. In participants with initial GDS scores > 11, there was a meanchange in GDS score of -5.6 +/- SD 3.9 for intervention participants (n = 13) and -3.4 +/- SD 4.5 for control participants (n = 21). Adjusting for differences in baseline characteristics between groups did not affect results. CONCLUSIONS: We were unable to demonstrate any benefit from case-finding for depression during 2 years of follow-up in elderly primary care patients. Studies are needed to determine whether case-finding combined with more intensive patient education and follow-up will improve outcomes of primary care patients with depression.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 06/04/20 alle ore 05:07:09