Treating Depression in the Primary Care Setting Proves Effective for Older Adults
The IMPACT treatment model is a stepped care program for the treatment of depression that utilizes a depression care manager who collaborates with the patient and the primary care physician and a psychiatrist as needed. Treatment includes depression education, Problem Solving Treatment, medication management, and behavioral activation. The patient is monitored closely using the PHQ-9 scale for depressive symptoms and the treatment plan is evaluated regularly to assure that new plans are developed as needed. A relapse prevention plan is developed when the patient is in remission to assure long term compliance.
I have been providing IMPACT depression care management to patients for the past seven years. I found this model to be very rewarding and effective as the research results verified and my personal experience confirmed. The results of the IMPACT clinical trials led by Dr. Jürgen Unützer showed that the IMPACT model of depression care more than doubles the effectiveness of depression treatment for older adults in primary care settings.
Older adult patients often express that it is easier to receive care from a person in the primary care office. They are less likely to go to a mental health clinic than younger adults and they express more concern about stigma. They often say they feel comfortable when the primary care physician says “Go see Rita in my office.” As older adults are often treated for numerous other conditions they appreciate that their care is coordinated with their PCP. IMPACT results concluded that with the collaborative care model, more patients in the intervention group received depression care as compared to those in usual care.
The IMPACT model of depression care is similar to care management programs for other chronic conditions like diabetes. We have a flyer in the PCP exam room which allows patients to talk to their PCPs easily about depression and PCPs aren?t reluctant to open the conversation because they know the care manager is available to follow up with the patient.
Depressed patients have poor adherence to treatment and worse health outcomes than non-depressed patients when treated for other chronic medical disorders. My patients improve their adherence to medical regimes as I reinforce the plans. I use “Problem Solving Treatment” at times to help them plan for how to get exercise or stay on a diet. I can discuss other medical issues that affect depression with the PCP more easily since my office is in primary care. Patients experience less pain and improved functioning as a result of the treatment. I think the improved continuity of care for patients in this system helps them to achieve these results.
Having a systematic way to evaluate the effectiveness of treatment using the PHQ-9 helps the patient and care manager have a clear goal for improvement and to plan changes in care accordingly. Treating depression in the primary care setting can be described as taking the depression blood pressure – patients and PCPs understand the concept and the numbers. The Problem Solving Treatment model empowers patients and teaches them skills that help them with interpersonal and medical problems.
Behavioral activation is an easily applied treatment that is helpful to all patients, even those who didn?t want therapy. I often found that patients who might have remained chronically depressed were more fully treated due to clear treatment goals and treatments that activate patients and increase their self efficacy.
As a mental health professional and cognitive / behavioral therapist, I have certainly found this model rewarding and effective.