Positive impact of a family practice-based depression case management on patient's self-management

Abstract

Objective

Family practice-based depression case management improves depression symptoms and adherence to medication. The aim of this study was to explore the long-term effects of practice-based depression case management on patient depression-related self-management knowledge and activities.

Methods

This long-term follow-up of a randomized controlled trial study took place 12 months after the end of the 1-year case management intervention. We used a modified version of the depression-specific self-management questionnaire described in Ludman et al. [Psychol Med, 33 (2003) 1061–1070]. Analyses of self-management knowledge and activities used a linear mixed model accounting for practice cluster effects and treatment group.

Results

Of the 626 patients included at baseline, 439 (70.1%) participated 24 months later in this follow-up study, i.e., 12 months after the end of the intervention. Compared to control recipients, intervention recipients presented statistically significant increased knowledge of medication side-effects and felt more able to avoid situations that may trigger depression. They also tried more often to undertake enjoyable activities and set more time aside for these activities.

Conclusion

This study suggests that case management improves depression-related self-management knowledge and activities in depressed primary care patients 12 months after the end of the intervention.

Practice implications

Clinicians may consider introducing practice-based case management for improving patients' self-management activities and knowledge.

Introduction

Depressive disorders are a burden to individuals and society [1], [2]. The prevalence of major depression among the German general population is 2–4% [3] and 5–11% among patients receiving care from a family doctor [4]. Up to 30% of the population is burdened by depressive symptoms at least once in their lives [5], [6], and the probability of a relapse is 75% among those who have had an episode of a major depression [7].

In a systematic review, Gilbody et al. [8] showed that structured treatment programs, such as case management, induce better results than traditional medical care. Depressive symptoms can also be improved by means of a multimodular family practice-based care management program [9]. Effective strategies to improve depression symptoms are mostly complex interventions that require extensive training for doctors and patients, a more active role for non-physician staff and a higher degree of integration between primary and secondary care [10], [11], [12], [13]. Case management is a regular component of these strategies. It includes systematic observation of the patients, support for the continuation of treatment and measures to be taken in case of nonadherence or a lack of improvement [14]. Evidence suggesting the positive effects of case management on symptom development in patients with depression is strong [11], [15], [16], [17], [18]. The positive effects may be due to an increase in depression-related self-management knowledge and activities, since patients may handle the disease more actively and independently to overcome the burden [19]. Perceived self-efficacy describes the patient's subjective sureness of his ability to handle difficult situations [20]. In contrast, self-management strives to activate a process of change that includes the patient's active involvement in his own current health situation by means of self-observation and the clarification of therapy goals [19], as also the Chronic Care Model has called for [21], [22]. However, evidence on long-term effects of improving patients' active self-management is still marginal. The aim of this study was to explore the long-term effects of a practice-based depression case management on patients' depression-related self-management knowledge and activities. We hypothesized that the case management intervention will improve self-management knowledge and activities.