Background: Few depressed older adults receive effective treatment in primary care.
Methods: Project IMPACT (Improving Mood: Promoting Access to Collaborative Treatment for Late-Life Depression) is a randomized controlled trial of a collaborative care program for late-life depression in primary care. 1,801 depressed older adults from 18 primary care clinics in 5 states were randomly assigned to the IMPACT intervention or to care as usual. Intervention subjects had access to a depression care manager (DCS) in primary care who was supervised by a consulting psychiatrist and a primary care physician for up to 12 months. The DCS offered education, care management, and support of antidepressant management by the patient’s primary care provider or problem-solving treatment in primary care (PST-PC), a brief, structured form of psychotherapy. Team psychiatrists consulted on the management of all patients and saw approximately 10 % of patients for in-person consultations in the primary care setting.
Results: During the 12 month study, intervention subjects experienced higher rates of depression treatment (P<0.0001) and satisfaction with depression care (P<0.0001), lower rates of major depression and lower depression severity (P<0.0001), less functional impairment (P<0.0001), and greater quality of life (P<0.0001) than participants assigned to usual care. IMPACT care was more effective than usual care at each of the 8 participating organizations. It was more effective than usual care for patients with and without comorbid anxiety and for patients from ethnic minority groups as well as whites. Impact participants with arthritis (N=1,002) experienced significantly greater reductions in pain and functional impairment due to arthritis than participants in usual care.
Conclusion: The IMPACT care model is feasible and significantly more effective than usual care in a wide range of patients and primary care practices.
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