Methods: Project IMPACT is a Randomized Controlled Trial (intervention versus care as usual). 1,801 patients were recruited at seven geographic study sites (18 primary care clinics) nationally. Randomization to intervention or usual care was carried out at the patient level. The intervention participants were supported by a care manager who provided medication support and or counseling (Problem Solving Treatment in Primary Care), depression management in collaboration with the patient's physician, and follow-up of outcomes and side effects. The care manager (Depression Clinical Specialist - DCS) was supervised by a psychiatrist and a primary care physician who were members of a study-based depression care team. The intervention was available to patients for up to 12 months. Surveys were conducted at 3, 6, and 12 months of participation for both intervention and care as usual subjects. 18- and 24-month follow-up interviews are on-going to assess whether intervention effects persist after removal of the care manager.
Significance: Late life depression is common but rarely treated successfully in primary care.
Impact: Project findings through the 12-month data point show that the IMPACT intervention model is about twice as effective as usual care in reducing depression symptoms, and that these effects are robust across all participating project sites. Intervention patients also had less functional impairment, and greater quality of life than patients in usual care.
Current status: 24 month follow-up interviews are complete. Long-term cost-effectiveness analyses are in progress.
Principal Investigators:
Jürgen Unützer, MD, MPH
Sponsored by:
John A. Hartford Foundation;
California HealthCare Foundation