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A New Sort of House Call
Depression afflicts 17 million Americans annually. But even with all the pharmacologic and non-pharmacologic treatments now available, it is estimated that only 25 to 30 percent of depressive patients receive the full and proper care they need. These low numbers are often attributed to the stigma of weakness still attached to depressive care, the lag between treatment and experienced benefit, and the seemingly imposing amount of time and energy needed to combat the illness. But when it comes to depression, even expecting such patient initiative might also be a problem.
So what if the responsibility to act was shifted away from patients and towards primary doctors and other caregivers? As a 2004 study shows, when doctors and caregivers take a more proactive stance towards antidepressive care, good things can happen.
In this case, researchers explored the benefits of outreach and psychotherapy conducted over the telephone. The study, a randomized controlled trial, divided 600 patient into 3 intervention groups: the first group received standard primary care for depression; the second group received primary care plus a telephone care management program consisting of three 15 minute outreach calls; and the third group received the telephone management program plus an 8 session cognitive-behavioral psychotherapy telephone program. Statistically significant improvements came with each increase in care; by the Hopkins Symptom Checklist Depression Scale, patients in the first, "standard" group improved by 55%, patients in the second, "telephone care management" group improved by 66%, and patients in the third, "psychotherapy" group improved by a resounding 80%. Patients in both telephone intervention groups had high satisfaction rates and more importantly, participation rates well past 90%.
In a field where patient non-compliance is a problem and treatment rates remain sluggish, these numbers show the benefits of a new, more assertive kind of treatment. Said Dr. Gregory Simon, lead author of the study, "We're turning the traditional notion on its head--the people [with depression] who are most motivated are in least need of our help. If we wait in our office for people to come to us, we'll be waiting a long time."
Beyond depression, studies have found telephone outreach and therapy variably effective for arthritis, smoking, and drug and alcohol addiction. The drug and alcohol study found that patients at a lesser risk of drug and alcohol abuse improved significantly with telephone therapy. But patients still at a great risk for abuse only improved with face-to-face counseling. The study concluded that telephone therapy could be helpful after the initial patient stabilization that comes with face-to-face encounters.
No one is arguing telephone conversations trump face-to-face encounters. Indeed, who knows the value of eye contact and body language in the doctor-patient relationship? But doctors can't be with all their patients all the time. And when patients fail to make appointments and fail to follow an antidepressant regimen, telephone outreach might be the next best thing for aggressive antidepressive care.
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