Telephone counseling as an adjunct to antidepressant treatment in the primary care system. A pilot study.

Abstract

CONTEXT: Many clinical and logistical barriers exist in the primary care model for treating adult depression. OBJECTIVE: To examine the feasibility and clinical effects of a telephone counseling and medication monitoring program for adults starting treatment for depression in primary care. DESIGN: Pilot study with a contemporaneous control group. SETTING: Group Health Cooperative, an HMO serving more than 450,000 persons in western Washington. PATIENTS: Twenty-eight adult primary care patients starting antidepressant treatment (telephone counseling group) were compared with 94 patients receiving usual care (control group). INTERVENTION: Telephone counseling participants received written educational materials addressing depression, followed by six weekly counseling and support sessions delivered over the telephone by a master's-level therapist. The intervention used the transtheoretical model of behavioral change and cognitive-behavioral strategies to enhance self-monitoring, self-management, and coping skills. DATA SOURCES: Telephone interviews and computerized pharmacy and visit records. OUTCOME MEASURES: Participation rate and retention, Hopkins symptom checklist depression scores, medication adherence and dose thresholds, and visits made for depression treatment. RESULTS: Ninety-three percent of telephone counseling participants contacted agreed to participate, and 92% completed the intervention. Telephone counseling patients showed significantly lower depressive symptoms than did control group patients at 3-month follow-up (0.89 vs. 1.13) and 6-month follow-up (0.79 vs. 0.95; P = 0.03). Telephone counseling patients were twice as likely to adhere to antidepressant medication with adequate dose thresholds (25% vs. 13%) and half as likely to meet criteria for major depression than were control group patients across time (8% vs. 16%), although these differences were not statistically significant. Total outpatient visits made for depression treatment between groups across time did not differ. Overall program cost per patient was estimated at about $150. CONCLUSIONS: A telephone counseling and medication monitoring intervention was well accepted by adult patients starting treatment for depression in primary care. The intervention seems to significantly improve depression outcomes without affecting the number of visits for treatment of depression.

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