Home health intervention effective for some depression

Medicare home healthcare nurses effectively integrated a depression care management program into routine practice, but the benefit appeared limited to those who had moderate to severe depression, according to a report published online by JAMA Internal Medicine.

The Depression Care for Patients at Home (Depression CAREPATH) trial by Martha L. Bruce, P.D, MPH, of the Weill Cornell Medical College, and colleagues, used specially trained home healthcare nurses to manage depression at routine home visits. The trial randomly assigned 178 nurses from six home health agencies to 12 Depression CAREPATH intervention teams or nine enhanced usual care teams. The study enrolled 306 Medicare home health patients aged at least 65 years who screened positive for depression; they were followed up at three, six and 12 months.

About 70 percent of patients were female, with an average age of 76.5 years. Depression severity was assessed using a scale score.

The intervention had no effect in the full sample of patients, the study found, nor did it have an effect in the subsample of patients who had mild depression (a depression score of less than 10). The intervention was effective among 208 patients with a depression score of 10 or greater, however.

“Medicare recommends depression screening and intervention, but the clinical needs of home healthcare patients, the scarcity of mental health specialists and the structure and practice of home healthcare pose challenges to this goal,” the authors conclude. “This effectiveness trial demonstrates that home healthcare nurses can effectively integrate [depression care management] into routine practice, with the clinical benefit to moderate to severely depressed patients extending beyond the home healthcare service period.”

The authors add that refinement to the tested approach could improve targeting of the intervention and that future research could evaluate benefits related to quality of life, aging in place and use of healthcare services.

In a related commentary, Constantine G. Lyketsos, MD, MHS, of the Johns Hopkins Bayview Medical Center, writes: “The work by Bruce and collaborators provides robust proof of the principle that good mental health outcomes for depressed individuals with complex chronic medical conditions receiving care at homes are possible and can be delivered as part of routine medical care, without further burdening existing service provision.”

Source: JAMA press release.

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