Telephonic case-finding of major depression in a Medicaid chronic disease management program for diabetes and heart failure

Ackermann, Ronald T.; Rosenman, Marc B.; Downs, Stephen M.; Holmes, Ann M.; Katz, Barry P.; Li, Jingjin; Zillich, Alan J.; Carney, Caroline P.; Inui, Thomas S.

doi:10.1016/j.genhosppsych.2005.05.009

« Previous Next »General Hospital Psychiatry
Volume 27, Issue 5 , Pages 338-343, September 2005

Telephonic case-finding of major depression in a Medicaid chronic disease management program for diabetes and heart failure

Ronald T. Ackermann, M.D., M.P.H.
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Corresponding author. 250 University Boulevard Suite 122; Indianapolis, IN 46202, USA. Tel.: +1 317 278 0906; fax: +1 317 278 0911.
Marc B. Rosenman, M.D.
- Regenstrief Institute, Inc., Indianapolis, IN 46202, USA
- Department of Pediatrics, Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN 46202, USA
Stephen M. Downs, M.D., M.S.
- Regenstrief Institute, Inc., Indianapolis, IN 46202, USA
- Department of Pediatrics, Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN 46202, USA
Ann M. Holmes, Ph.D.
- School of Public and Environmental Affairs, Indiana University Purdue University, Indianapolis, IN 46202, USA
Barry P. Katz, Ph.D.
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
Jingjin Li, Ph.D.
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Regenstrief Institute, Inc., Indianapolis, IN 46202, USA
Alan J. Zillich, Pharm.D.
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Regenstrief Institute, Inc., Indianapolis, IN 46202, USA
- Department of Pharmacy Practice, Purdue University School of Pharmacy and Pharmaceutical Sciences, Indianapolis, IN 46202, USA
Caroline P. Carney, M.D., M.Sc.
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Regenstrief Institute, Inc., Indianapolis, IN 46202, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA
Thomas S. Inui, M.D., Sc.M.
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Regenstrief Institute, Inc., Indianapolis, IN 46202, USA

Received 17 March 2005; accepted 17 May 2005.

Abstract

Objective

Major depression is common in low-income and chronically ill persons and is a barrier for effective chronic disease care. We evaluated a Medicaid-sponsored strategy for detecting depressive symptoms in adults with diabetes or congestive heart failure.

Methods

Using a two-item screening tool, 890 adults enrolled in the Indiana Chronic Disease Management Program were assessed by telephone for depressive symptoms between December 2003 and March 2004. A subset of 386 participants also completed the eight-item Patient Health Questionnaire (PHQ-8) depression measure. Antidepressant use was examined using pharmacy claims.

Results

Depressed mood or anhedonia was reported by 51% of participants. About one in four participants had a PHQ-8 score indicating a high risk for major depression (score ≥10). The two-item screen was 96% sensitive [95% confidence interval (CI), 89–99%] and 60% specific (95% CI, 54–65%) for identifying members at high risk for depression by the full PHQ-8 instrument. Only half of participants with high-risk PHQ-8 scores had a pharmacy claim indicating that an antidepressant medication was filled within 120 days of the depression screening.

Conclusions

A two-stage, telephonic approach involving the PHQ-8 instrument for Medicaid members with either depressed mood or anhedonia could identify two clinically depressed persons for every nine members screened.

Keywords: Depression, Disease management, Chronic disease, Medicaid, Mass screening