Congestive heart failure and depression in older adults: clinical course and health services use 6 months after hospitalization.

The course of depression and the economic consequences in the 6-month period after hospitalization for congestive heart failure were examined in a prospective observational cohort study involving 203 older adults (mean age=76.8 years, SD=7.8). At discharge, 73 of 203 subjects (36%) were depressed according to the screening criteria of the Geriatric Depression Scale, and 44 (22%) were depressed according to the Structured Clinical Interview for DSM-III-R-Non-Patient Edition. The proportions were 33% and 20% of 166 subjects, respectively, at 4 weeks and 26% and 17% of 113 subjects, respectively, at 24 weeks. Depressed patients used more medical resources after discharge than nondepressed patients. Additional research is required to determine whether the optimal time to identify and treat depressed older adults with congestive heart failure is during a hospital stay or after discharge.

Evaluation of a depression health management program to improve outcomes in first or recurrent episode depression.

OBJECTIVES: To evaluate the impact of telephone counseling and educational materials on medication adherence and persistency among members with newly diagnosed depression enrolled in a pharmacy benefit management-sponsored disease management program. STUDY DESIGN: Longitudinal cohort observation. METHODS: The study population comprised 505 members with a new or recurrent episode of depression who consented and enrolled in a depression disease management program. After written consent was obtained, program participants received up to 4 telephone-counseling calls and 5 educational mailings focused on the importance of medication compliance, barriers to medication compliance, quality of life, symptoms, and satisfaction with the program. A control group of 3744 members was selected from client companies that opted not to offer the depression program. Measures of medication adherence, persistency with prescription drug therapy, and patient refill timeliness were computed for both groups and compared. RESULTS: Patients enrolled in the depression disease management program were significantly more likely to adhere to their medication regimen during acute (89.0% vs 67.7%, P < .001) and continuation treatment phases (81.1% vs 57.6%, P < .001). In addition, members enrolled in the program were significantly more likely to continue their therapy after 7 months (77.8% vs 49.5%, P < .001) and refilled their prescriptions on a more timely basis (0 vs 18 days, P < .001). CONCLUSIONS: A pharmacy benefit management-sponsored health management depression program succeeded in encouraging patients with new or recurrent depression to stay on antidepressant medication and to reach treatment goals outlined by best practice guidelines.