Generalist care managers for the treatment of depressed medicaid patients in North Carolina: A pilot study Public Deposited

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Creator
  • Domino, Marisa
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
  • Morrissey, Joseph P.
    • Affiliation: Cecil G. Sheps Center for Health Services Research
  • Gaynes, Bradley
    • Affiliation: School of Medicine, Department of Psychiatry
  • Landis, Suzanne E
    • Affiliation: School of Medicine, Department of Family Medicine
    • Other Affiliation: Mountain Area Health Education Center
  • Vinson, Nina
    • Other Affiliation: SAGE Partners, Inc. Asheville, NC, USA
  • Ellis, Alan R
    • Affiliation: Cecil G. Sheps Center for Health Services Research
Abstract
  • Abstract Background In most states, mental illness costs are an increasing share of Medicaid expenditures. Specialized depression care managers (CM) have consistently demonstrated improvements in patient outcomes relative to usual primary care (UC), but are costly and may not be fully utilized in smaller practices. A generalist care manager (GCM) could manage multiple chronic conditions and be more accepted and cost-effective than the specialist depression CM. We designed a pilot program to demonstrate the feasibility of training/deploying GCMs into primary care settings. Methods We randomized depressed adult Medicaid patients in 2 primary care practices in Western North Carolina to a GCM intervention or to UC. GCMs, already providing services in diabetes and asthma in both study arms, were further trained to provide depression services including self-management, decision support, use of information systems, and care management. The following data were analyzed: baseline, 3- and 6-month Patient Health Questionnaire (PHQ9) scores; baseline and 6-month Short Form (SF) 12 scores; Medicaid claims data; questionnaire on patients' perceptions of treatment; GCM case notes; physician and office staff time study; and physician and office staff focus group discussions. Results Forty-five patients were enrolled, the majority with preexisting depression. Both groups improved; the GCM group did not demonstrate better clinical and functional outcomes than the UC group. Patients in the GCM group were more likely to have prescriptions of correct dosing by chart data. GCMs most often addressed comorbid conditions (36%), then social issues (27%) and appointment reminders (14%). GCMs recorded an average of 46 interactions per patient in the GCM arm. Focus group data demonstrated that physicians valued using GCMs. A time study documented that staff required no more time interacting with GCMs, whereas physicians spent an average of 4 minutes more per week. Conclusion GCMs can be trained in care of depression and other chronic illnesses, are acceptable to practices and patients, and result in physicians prescribing guideline concordant care. GCMs appear to be a feasible intervention for community medical practices and to warrant a larger scale trial to test their appropriateness for Medicaid programs nationally.
Date of publication
Identifier
  • doi:10.1186/1471-2296-8-7
  • 17338822
Resource type
  • Article
Rights statement
  • In Copyright
Rights holder
  • Suzanne E Landis et al.; licensee BioMed Central Ltd.
License
Journal title
  • BMC Family Practice
Journal volume
  • 8
Journal issue
  • 1
Page start
  • 7
Language
  • English
Is the article or chapter peer-reviewed?
  • Yes
ISSN
  • 1471-2296
Bibliographic citation
  • BMC Family Practice. 2007 Mar 05;8(1):7
Access
  • Open Access
Publisher
  • BioMed Central Ltd
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