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BMC Family Practice

, 8:7

First Online: 05 March 2007Received: 29 August 2006Accepted: 05 March 2007


BackgroundIn most states, mental illness costs are an increasing share of Medicaid expenditures. Specialized depression care managers CM have consistently demonstrated improvements in patient outcomes relative to usual primary care UC, but are costly and may not be fully utilized in smaller practices. A generalist care manager GCM could manage multiple chronic conditions and be more accepted and cost-effective than the specialist depression CM. We designed a pilot program to demonstrate the feasibility of training-deploying GCMs into primary care settings.

MethodsWe randomized depressed adult Medicaid patients in 2 primary care practices in Western North Carolina to a GCM intervention or to UC. GCMs, already providing services in diabetes and asthma in both study arms, were further trained to provide depression services including self-management, decision support, use of information systems, and care management. The following data were analyzed: baseline, 3- and 6-month Patient Health Questionnaire PHQ9 scores; baseline and 6-month Short Form SF 12 scores; Medicaid claims data; questionnaire on patients- perceptions of treatment; GCM case notes; physician and office staff time study; and physician and office staff focus group discussions.

ResultsForty-five patients were enrolled, the majority with preexisting depression. Both groups improved; the GCM group did not demonstrate better clinical and functional outcomes than the UC group. Patients in the GCM group were more likely to have prescriptions of correct dosing by chart data. GCMs most often addressed comorbid conditions 36%, then social issues 27% and appointment reminders 14%. GCMs recorded an average of 46 interactions per patient in the GCM arm. Focus group data demonstrated that physicians valued using GCMs. A time study documented that staff required no more time interacting with GCMs, whereas physicians spent an average of 4 minutes more per week.

ConclusionGCMs can be trained in care of depression and other chronic illnesses, are acceptable to practices and patients, and result in physicians prescribing guideline concordant care. GCMs appear to be a feasible intervention for community medical practices and to warrant a larger scale trial to test their appropriateness for Medicaid programs nationally.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2296-8-7 contains supplementary material, which is available to authorized users.

Suzanne E Landis, Joseph P Morrissey contributed equally to this work.

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Autor: Suzanne E Landis - Bradley N Gaynes - Joseph P Morrissey - Nina Vinson - Alan R Ellis - Marisa E Domino


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