In collaborative care, a non-physician care manager coordinates a patient’s care with both a primary doctor and a psychiatrist. The care manager also educates the patient about depression, treatment options, and depression’s effects on heart disease. He or she also follows up with the patient to assess how well the patient is doing and whether the patient is sticking to the prescribed treatment.
In this six-month study, published in Circulation: Cardiovascular Quality and Outcomes, researchers followed 175 heart disease patients who had also been diagnosed with depression. The treatment the participants received began while they were still in the hospital, where they had been admitted for an abnormal heart rhythm, unstable angina, heart attack, or heart failure. According to the researchers, this is a critical time to intervene.
“That patients were easily identified and effective treatment begun before discharge is a crucial aspect of our study -- with a minimal amount of effort, those patients most in need for treatment received effective therapy before discharge, when the likelihood for missed opportunity to apply effective treatment rises,” the researchers write.
At the six-week mark, nearly 60% of the patients in the collaborative care group reported that their symptoms of depression had dropped by half. Only a third of the patients who received standard care experienced similar improvements.
At 12 weeks, the comparison between the groups held steady, for the most part. There was a slight decline in improvement among the study group. By six months, these effects had begun to wear off and there was no significant difference in improvement between the two groups.
The study had another significant finding. While medical outcomes did not change for either group, the patients who received collaborative care reported fewer cardiac symptoms and greater adherence to a healthy diet and exercise regimen at six months after the start of the study. This finding, the researchers write, is intriguing and requires further study to understand the link between relief from depression and subsequent reduction in heart disease symptoms.