Prospect of Care IMPACT Studied through PRISM-E

Article excerpt

"We now have evidence that integrated collaborative care works better for older people in primary care," stated Stephen J. Bartels, director of Aging Services Research at Dartmouth Medical School, Lebanon, N.H. Speaking at the 2003 Joint Conference of the National Council on the Aging and the American Society on Aging last spring, he outlined three major studies examining whether the integration of mental health services for elders into primary care practices is better than usual care.

"The issue is that the service-delivery system is hugely fragmented for older people who require mental health services," he said. Bartels, a consultant to the President's New Freedom Commission on Mental Health, called it "unprecedented to have three parallel, multisite studies happening at the same time to answer such a critical question-so it's hugely exciting." The studies also aim to compare treatment costs with how much untreated depression drives up the bill for health-services utilization by older adults, he said.

Following are brief summaries of the studies:

Project IMPACT: Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) for late-life depression is an $11 million, five-year randomized controlled trial at seven locations in five states. Launched in 1999 by the John A. Hartford Foundation, the study involved 1,800 individuals in a one-year intervention for people age 60 or older. Participants receiving the team intervention, compared with those who received only usual care, were given antidepressants along with 6-8 sessions of psychotherapy, if needed. They met weekly with a geriatric physician and team psychiatrist, and a clinical specialist in depression managed the care.

"Outcomes were much better than expected," according to a Hartford report on the study. "The IMPACT team-care approach more than doubles the effectiveness of depression treatment for older adults in primary care settings." The Hartford Foundation's 2002 Annual Report, which devotes its entire 75 pages to the study, can be downloaded at www. port.pdf. An article about the research findings titled "Collaborative Care Management of Late-Life Depression in the Primary Care Setting," by Jurgens Unutzer and colleagues, appeared in the Journal of the American Medical Association, Dec. …