Randomized Trial of a Telephone Care Management Program for Outpatients Starting Antidepressant Treatment

OBJECTIVE: This study evaluated the effectiveness of a structured telephone-based care management program for patients in a prepaid health plan receiving new antidepressant prescriptions from psychiatrists. METHODS: Potential participants were identified with computerized medical records and contacted by telephone. Eligible and consenting participants were randomly assigned to continued usual care (N=104) or to a three-session telephone care management program (N=103). Care management contacts included assessment of depressive symptoms, medication adherence, and medication side effects with structured feedback to treating psychiatrists. Effectiveness was assessed three and six months after randomization by blinded telephone assessments (depression scale on the Hopkins Symptom Checklist SCL and patient-rated global improvement). Computerized records were used to assess medication adherence and frequency of in-person follow-up visits. RESULTS: Compared with usual care, the care management intervention had no significant effect on the mean score of the SCL depression scale at six months, on the probability of 50 percent improvement in depressive symptoms (41 percent for care management and 37 percent for usual care), or on the probability of patient-rated improvement (57 percent for care management and 52 percent for usual care). Patients assigned to care management made significantly more medication management visits over six months (2.4 visits compared with 2.0 visits; p=.035), but there were no significant differences in rates of adequate medication treatment. CONCLUSIONS: This study found that a low-intensity telephone care management program did not appear to significantly improve clinical outcomes for patients starting antidepressant treatment. Compared with findings from earlier primary care studies, this study found that patients receiving care from a psychiatrist received more intensive treatment, although many still experienced poor outcomes.