Trial integrates depression and BP treatment
Patients in the integrated-care arm showed fewer depressive symptoms and lower BP than those in a control group. The integrated-care group was also much more successful at attaining at least 80% compliance with their drug regimens (71.9% for antidepressants and 78.1% for antihypertensives vs. 31.3% for each type of medication among the controls) (Ann Fam Med. 2008;6:295-301).
“Managing depression in the context of medical comorbidity may be more acceptable to patients than managing depression alone,” note the researchers from the University of Pennsylvania School of Medicine in Philadelphia. “This trial focused on integrating depression management into care for hypertension.”
Participants ranging in age from 50 to 80 years were recruited at a large local primary-care practice. Fifty-two (81.2%) identified themselves as African American; 11 (17.2%) as white; and one (1.6%) as “other.” Approximately three quarters of the patients (76.6%) were women.
Half were randomly assigned to an “integrated-care intervention”; the rest received usual care. The intervention group had three 30-minute in-person sessions and two 15-minute telephone contacts with an integrated-care manager over a four-week period.
That manager was a researcher who educated the patients about depression and hypertension, explained the rationale for their medication, assessed progress and side effects, and “offered encouragement and relief from stigma.”
At final assessments, patients in the integrated-care group showed fewer depressive symptoms on the Center for Epidemiologic Studies Depression Scale, with a mean score of 9.9 vs. 19.3 among those receiving usual care. Integrated-care patients also had lower average systolic BP (127.3 mm Hg vs. 141.3) and diastolic BP (75.8 mm Hg vs. 85.0).
“These findings are aligned with recent findings that older primary-care patients are more likely to be engaged in integrated care than other forms of care provision, and integrated-care models are particularly effective in improving access to and participation in mental- health services among African American primary-care patients,” the authors conclude.