By Matt McMillen
WebMD Health News
Reviewed by Laura J. Martin, MD
In collaborative care, a non-physician care manager coordinates a patient's care with both a primary doctor and a psychiatrist. The care manager also educates the patient about depression, treatment options, and depression's effects on heart disease. He or she also follows up with the patient to assess how well the patient is doing and whether the patient is sticking to the prescribed treatment.
In this six-month study, published in Circulation: Cardiovascular Quality and Outcomes, researchers followed 175 heart disease patients who had also been diagnosed with depression. The treatment the participants received began while they were still in the hospital, where they had been admitted for an abnormal heart rhythm, unstable angina, heart attack, or heart failure. According to the researchers, this is a critical time to intervene.
"That patients were easily identified and effective treatment begun before discharge is a crucial aspect of our study -- with a minimal amount of effort, those patients most in need for treatment received effective therapy before discharge, when the likelihood for missed opportunity to apply effective treatment rises," the researchers write.
Early Intervention Pays Off
At the six-week mark, nearly 60% of the patients in the collaborative care group reported that their symptoms of depression had dropped by half. Only a third of the patients who received standard care experienced similar improvements.
At 12 weeks, the comparison between the groups held steady, for the most part. There was a slight decline in improvement among the study group. By six months, these effects had begun to wear off and there was no significant difference in improvement between the two groups.
The study had another significant finding. While medical outcomes did not change for either group, the patients who received collaborative care reported fewer cardiac symptoms and greater adherence to a healthy diet and exercise regimen at six months after the start of the study. This finding, the researchers write, is intriguing and requires further study to understand the link between relief from depression and subsequent reduction in heart disease symptoms.
"Depressed patients may need improvement of their mental health condition before they are able to take on improvement of their cardiac health behaviors," they write.
As the researchers acknowledge, the collaborative care model they used for this study was not very intense. Patients only received three follow-up phone calls over the course of six months. However, the fact that such a minimal intervention could have such a significant short-term impact leads them to speculate that more intense follow-through could improve outcomes dramatically.
"Future collaborative care studies in this population should include larger cohorts and longer follow-up, provide greater intensity and duration of care manager interventions and an evidence-based psychotherapy option, and may consider specific interventions for health behaviors and physical symptoms, to allow a greater chance of reducing major cardiac events and mortality in this vulnerable population," the researchers conclude.
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