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Disease Management for Depression and At-Risk Drinking Via Telephone in an Older Population of Veterans

From Section of Geriatric Psychiatry (D.W.O., J.R.), Department of Psychiatry, University of Pennsylvania, Philadelphia, PA; Center for the Study of Addictions (D.W.O., S.S.), Department of Psychiatry, University of Pennsylvania, Philadelphia, PA; Philadelphia VA Medical Center and VISN 4 MIRECC (D.W.O., S.S., V.K.); Department of Epidemiology and Biostatistics (T.T.H.), University of Pennsylvania, Philadelphia, Pennsylvania; and University of Pittsburgh School of Medicine (J.C., J.C.), the Pittsburgh VAMC, and VISN 4 MIRECC.

Address correspondence and reprint requests to David Oslin, MD, University of Pennsylvania, 3535 Market Street, Room 3002, Philadelphia, PA 19104. E-mail: oslin{at}mail.med.upenn.edu

OBJECTIVES: The purpose of this study was to explore the efficacy in a primary care setting of a telephone-based disease management program for the acute management of depression and/or at-risk drinking.

MATERIALS AND METHODS: Veterans (N= 97) with depression and/or at-risk drinking were identified by systematic screening and assessment. Eligible subjects received either telephone disease management (TDM) program or usual care based on random assignment of their clinician. The TDM program consisted of regular contacts with each subject by a behavioral health specialist (BHS) to assist in assessment, education, support, and treatment planning. Symptomatic outcomes were assessed at 4 months.

RESULTS: Overall response rates favored those assigned to TDM compared with those assigned to usual care (39.1% responded vs. 17.6%, p= 0.022). Response rates within the separate diagnostic groups also favored TDM, but this was only significant for depressive disorders.

CONCLUSIONS: Although the sample size was modest and the sample was limited to veterans, findings strongly suggest that a telephone-based disease management program can improve outcomes for patients with a behavioral health problem. Findings also suggest that a health specialist can focus and manage patients with different diagnoses, thus expanding the role beyond just depression care. TDM may be a viable, low-cost, model for primary care clinicians to deliver manual guideline-adherent behavioral health care, especially in a VA clinical setting.

Key Words: telephone, • depression, • at-risk drinking, • primary care.

Abbreviations: TDM = telephone disease management;; PCP = primary care physician;; CESD = Center for Epidemiological Studies depression scale;; BOMC = Brief Orientation Memory Concentration test;; AHRQ = Agency for Healthcare Research and Quality;; VA = Department of Veterans Affairs;; BHS = behavioral health specialist;; HDRS = Hamilton Depression Rating scale;; ADS = Alcohol Dependence Scale;; SSRI = serotonin selective reuptake inhibitor.

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