Over the Phone Depression Counseling
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Denver Health and Hospitals Foundation
Denver, Colorado
Depression
Federally qualified health centers
Latinos, African Americans |
PROJECT
Patients received depression assessment, support and counseling over the phone.
A six-session, scripted telephone counseling protocol is delivered by mental health clinicians to improve medication adherence and promote behavioral activation in ways that help patients experience reward and pleasure in their lives. Mental health clinicians receive training on how to provide culturally effective care. Additionally, bilingual mental health clinicians and culturally tailored print materials are made available to Spanish-speaking participants. After each call, patients receive a letter summarizing the discussion and a list of “homework” assignments to be completed before the next call. Primary care physicians receive feedback on their patients’ mental health diagnoses and depression severity levels, along with updated disease management recommendations after every other counseling session. Participants are Federally Qualified Health Centers (FQHCs) that are part of Denver Health and Hospitals Foundation, a public safety net health care system.
RATIONALE
Primary care physicians are increasingly responsible for diagnosing and treating depression, but their management of depression has been less than optimal. Their management is often characterized by low medication adherence and adjustment, low levels of mental health assessment and consultation with mental health specialists, and a lack of evidence-based psychotherapy. These problems are even more pronounced for low-income minority patients.
This study aims to improve the management of depression by providing telephone-based assessment, counseling and monitoring. The intervention is based on a Behavioral Activation approach, a relatively simple intervention that is easy for depressed patients to understand and does not require difficult or complex skills to implement. The telephone-based care management and therapy program has the potential to improve clinical outcomes, while being less costly and easier to establish than collaborative care or practice-based reorganizations. In particular, the telephone-based intervention program may increase adherence to antidepressant medications.
EVALUATION PLAN
Funded by Finding Answers in 2009.
Patients who receive a new prescription for an SSRI antidepressant medication from their primary care physician are being recruited to participate in a randomized controlled trial. Patients randomized into the intervention group are receiving a series of five assessment and counseling telephone calls. Patients randomized into the control group are receiving their usual care. Primary outcomes are being evaluated at six, 12 and 24 weeks and include depression symptom improvement. The patients’ primary care physicians are also being evaluated at six, 12 and 24 weeks, to assess their response to management recommendations. Secondary outcomes are also being evaluated, including changes in medication adherence and behavioral activation, cost offsets (urgent care and emergency services use and hospitalizations), the impact of moderating and mediating variables, and an assessment of depression severity and psychiatric comorbidity. Key informant interviews with staff, clinicians and patients are identifying elements of the study to be targeted in future evaluation efforts.
Principal Investigators:
- David S. Brody, MD (Medical Director, Denver Health)
- Jeanette Waxmonsky, PhD (Assistant Professor, University of Colorado-Denver School of Medicine)
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