| 1. |
- af Winklerfelt Hammarberg, Sandra, et al.
(författare)
-
Clinical effectiveness of care managers in collaborative primary health care for patients with depression : 12-and 24-month follow-up of a pragmatic cluster randomized controlled trial
- 2022
-
Ingår i: BMC Primary Care. - : Springer Nature. - 2731-4553. ; 23:1
-
Tidskriftsartikel (refereegranskat)abstract
- Background In previous studies, we investigated the effects of a care manager intervention for patients with depression treated in primary health care. At 6 months, care management improved depressive symptoms, remission, return to work, and adherence to anti-depressive medication more than care as usual. The aim of this study was to compare the long-term effectiveness of care management and usual care for primary care patients with depression on depressive symptoms, remission, quality of life, self-efficacy, confidence in care, and quality of care 12 and 24 months after the start of the intervention. Methods Cluster randomized controlled trial that included 23 primary care centers (11 intervention, 12 control) in the regions of Vastra Gotaland and Dalarna, Sweden. Patients >= 18 years with newly diagnosed mild to moderate depression (n = 376: 192 intervention, 184 control) were included. Patients at intervention centers co-developed a structured depression care plan with a care manager. Via 6 to 8 telephone contacts over 12 weeks, the care manager followed up symptoms and treatment, encouraged behavioral activation, provided education, and communicated with the patient's general practitioner as needed. Patients at control centers received usual care. Adjusted mixed model repeated measure analysis was conducted on data gathered at 12 and 24 months on depressive symptoms and remission (MADRS-S); quality of life (EQ5D); and self-efficacy, confidence in care, and quality of care (study-specific questionnaire). Results The intervention group had less severe depressive symptoms than the control group at 12 (P = 0.02) but not 24 months (P = 0.83). They reported higher quality of life at 12 (P = 0.01) but not 24 months (P = 0.88). Differences in remission and self-efficacy were not significant, but patients in the intervention group were more confident that they could get information (53% vs 38%; P = 0.02) and professional emotional support (51% vs 40%; P = 0.05) from the primary care center. Conclusions Patients with depression who had a care manager maintained their 6-month improvements in symptoms at the 12- and 24-month follow-ups. Without a care manager, recovery could take up to 24 months. Patients with care managers also had significantly more confidence in primary care and belief in future support than controls.
|
|
| 2. |
- Björkelund, Cecilia, 1948, et al.
(författare)
-
Using patient-centred consultation when screening for depression in elderly patients: A comparative pilot study
- 2011
-
Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 29:1, s. 51-56
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. Using validated screening instruments to detect depressive symptoms in the elderly has been recommended. The aim of this study was to compare a patient-centred consultation model with the PRIME-MD screening questionnaire, using the MADRS-S as reference for detecting depressive symptoms in an elderly primary care population. Design. Comparative study. Setting. Primary care, Sweden. Subjects. During an 11-month period 302 consecutive patients aged 60 and over attending a primary care centre were screened with the PRIME- MD and the Montgomery-Asberg Depression Rating Scale-Self-rated version (MADRS-S) instrument. The results were unknown to the GPs who used a structured, patientcentred consultation model comprising seven open-ended “key questions”. Main outcome measures. Sensitivity, specifi city, positive predictive values (PPV), and negative predictive values (NPV) were calculated for the PRIME-MD screening questionnaire and the patient-centred consultation model using MADRS-S as reference for possible depression at two cut-off levels with 15% prevalence. Results. Sensitivity was lower for the consultation model than the PRIME-MD screening questionnaire: 78% and 98%, respectively. The GPs failed to identify every fi fth patient using the lower cut-off (MADRS-S 13) but the number of required diagnostic interviews decreased by almost 50%: 85 versus 162, respectively. PPV was 43% and 28%, respectively. Both instruments showed high sensitivity (93%) using the higher cut-off (MADRS-S 20) and had high NPV: 95% and 99%, respectively. Conclusions. The fi ndings suggest that the consultation screening procedure might be as useful in everyday practice as the PRIME-MD screening questionnaire. Both screening procedures may also be useful for ruling out depressive symptoms.
|
|
| 3. |
|
|
| 4. |
- Magnil, Maria, 1952, et al.
(författare)
-
Course, risk factors, and prognostic factors in elderly primary care patients with mild depression: A two-year observational study
- 2013
-
Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 31:1, s. 20-25
-
Tidskriftsartikel (refereegranskat)abstract
- Objective. The aim of this study was to observe course, risk factors, and prognostic factors in a primary care cohort aged 60 with mild to moderate depression during two-year follow-up. Design. Observational study. Setting. Primary care. Subjects and method. During an 11-month period all (n 302) consecutive patients aged 60 and above attending a primary care centre in Gothenburg, Sweden were screened by a nurse for depressive symptoms with the Primary Care Evaluation of Mental Disorders, Patient Questionnaire (PRIME-MD PQ) and the Montgomery- Å sberg Depression Rating Scale, self- rated version (MADRS-S) and by a GP with a patient-centred consultation model. In the second step, the GPs diagnosed depression in screen-positives by use of the PRIME-MD Clinical Evaluation Guide (PRIME-MD CEG). All patients with mild to moderate depression were followed up for two years to assess course with several MADRS-S score assessments. Main outcome measures. Risk factors, prognostic factors, and symptoms at baseline and after two years were tested with logistic regression, using the DSM-IV and MADRS-S (cut-off 13) respectively. Course patterns were observed and described. Results. A total of 54 patients were diagnosed with depression. Follow-up revealed declining median MADRS-S scores and three course patterns: remitting, stable, and fl uctuating. History of depression, signifi cant life events, lacking leisure activities, and use of sedatives were risk factors for depression, all previously known. An important fi nding was that lacking leisure activities also increased the risk of depressive symptoms after two years (odds ratio 12, confi dence interval 1.1 – 136). Conclusion. It is desirable to identify elderly individuals with less severe depression. Three course patterns were observed; this fi nding requires further study of the clinical characteristics related to the different patterns. Awareness of risk factors may facilitate identifi cation of those at highest risk of poor prognosis.
|
|
| 5. |
- Magnil, Maria, 1952
(författare)
-
Mild to moderate depression in the elderly in primary care - detection, patient centeredness and course
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims; To study the prevalence of and describe factors associated with depressive symptoms and to observe the course in a cohort of elderly primary care patients with mild to moderate depression. To compare a structured patient-centered consultation model with a validated instrument when screening for depressive symptoms and to investigate if recommended cut-off values for a self-rated instrument should be adjusted for this population. Method; Cross-sectional data were collected for all papers from one observational two-year follow-up study, using questionnaires, interviews, consultations and medical records. Consecutive patients aged 60 and up were screened for depressive symptoms at a primary care center in 2003. Included patients (n=302) completed the Primary Care Evaluation of Mental Disorders Patient Questionnaire (PRIME-MD PQ); the Montgomery-Åsberg Depression Rating Scale, self-rated version (MADRS-S); and a structured interview with a nurse. They then saw a general practitioner (GP) who assessed whether there was “possible depression”, with a structured patient-centered consultation model. The psychometric properties of the consultation model and the PRIME-MD PQ were calculated using the MADRS-S, at two cut-off levels, as a reference. The GPs performed a diagnostic interview using the PRIME-MD Clinical Evaluation Guide (CEG) with patients who had screened positive with any of the methods. In patients with mild to moderate depression (n=54), the course was observed during two years and risk factors and prognostic factors were studied. The optimal MADRS-S cut-off value for a depressive diagnosis was calculated by Receiver Operating Characteristic (ROC) curve. Logistic regression analysis was used for studying associations between the different variables and depressive symptoms as well as mild to moderate depression. Results Several psychosocial factors and somatic symptoms were associated with depressive symptoms. The point prevalence of depressive symptoms was 15 % (Paper I). The consultation model exhibited moderate to good properties for screening for depressive symptoms in the elderly (Paper II).While median MADRS-S scores declined during a two-year follow-up period, three course patterns were identified: remitting, stable, and fluctuating (Paper III). There were indications that the MADRS-S cut-off value should be lowered when screening for mild to moderate depression in this group (Paper IV). Conclusion Most elderly individuals with milder forms of depressive disorders are seen and treated in primary care. They are important to recognize since the conditions are associated with considerable functional disability and morbidity. A structured patient-centered consultation model, adjusting self-rated instruments’ cut-off values and knowledge of risk factors, prognostic factors, and course may be helpful for GPs in detecting, assessing, and managing depressive disorders in elderly primary care patients.
|
|
| 6. |
- Magnil, Maria, 1952, et al.
(författare)
-
Prevalence of depressive symptoms and associated factors in elderly primary care patients: a descriptive study
- 2008
-
Ingår i: Primary Care Companion to The Journal of Clinical Psychiatry. - 1523-5998. ; 104:6, s. 462-468
-
Tidskriftsartikel (refereegranskat)abstract
- ACKGROUND: Depressive symptoms are common in older adults. A majority will be seen in primary care. The aim was to study the prevalence of and to explore factors associated with depressive symptoms in elderly primary care patients. METHOD: In consecutive patients aged 60 years and older attending a Swedish primary care center between February and December of 2003, depressive symptoms were identified as >/= 13 points on the Montgomery-Asberg Depression Rating Scale-Self-Rated version (MADRS-S). Somatic symptoms measured according to PRIME-MD, age, socioeconomic status, gender, somatic diagnoses, and medication were analyzed in relation to presence of depressive symptoms. RESULTS: Forty-six of 302 patients (15%) rated themselves in the depressed range. There were no differences between depressed and nondepressed patients concerning socioeconomic status, other illnesses, or medication except for use of sedatives/hypnotics being more common (OR = 2.7, 95% CI = 1.3 to 5.6) in depressed patients. Patients in the group scoring >/= 13 on the MADRS-S were more likely to have become widowed during the last year (OR = 6.0, 95% CI = 1.7 to 20.8) or to have indicated significant life events (OR = 4.3, 95% CI = 2.0 to 9.0), but were less likely to report having leisure time activities (OR = 0.2, 95% CI = 0.08 to 0.41) or perception of good health (OR = 0.1, 95% CI = 0.05 to 0.3). Patients being treated for depression did not have increased depression scores (OR = 1.4, 95% CI = 0.66 to 3.1). CONCLUSION: In a group of unselected primary care elderly patients, the prevalence of depressive symptoms was high. Use of sedatives/hypnotics was remarkably common in patients with depressive symptoms. Patients with ongoing treatment of depression did not have increased depression scores, indicating the good prognosis for treated depression in the elderly.
|
|
