Posted by: Pulse Clinical Team15 April 2014
A telephone-based model to concurrently manage cardiac patients with depression or anxiety disorders is effective for improving mental health-related quality of life, shows a recent study.
The single-blind randomised clinical trial comprised of 183 patients admitted to inpatient cardiac units for acute coronary syndrome, arrhythmia, or heart failure and found to have clinical depression, generalised anxiety disorder, or panic disorder on assessment.
Participants were randomised to 24 weeks of a telephone-based collaborative care intervention targeting depression and anxiety disorders (n=92), or to enhanced usual care (n=91). The intervention involved a social work care manager, in conjunction with a team of psychiatrists, coordinating assessment and stepped care of psychiatric conditions and providing support and therapeutic interventions as appropriate. Patients in the collaborative care group received a 15-30 minute follow-up call within two weeks of discharge, and additional telephone sessions were scheduled for various intervals depending on the treatment plan (i.e. pharmacotherapy or weekly CBT). Improvement in mental health-related quality of life – using the Short Form-12 Component Score (SF-12 MCS) – at week 24 was used to compare mental health states between the two participant groups.
Patients randomised to collaborative care had significantly greater improvements in estimated mean SF-12 MCS at 24 weeks (11.21 points in the collaborative care group versus 5.53 points in the control group). Patients receiving collaborative care also had significant improvements in depressive symptoms – an estimated mean difference of -2.05 in PHQ-9 scores between groups. There was no significant difference in SF-12 MCS scores between men and women.
The researchers note that ‘given the relatively low-burden and low-resource nature of this intervention – with telephone delivery of all post-discharge interventions and use of a single social worker as the non-physician care manager for three psychiatric illnesses – such a programme may be easily implemented and effective in real world settings’.