IMPACT: A Primary Care Approach to Late Life Depression

DESCRIPTION (provided by applicant): There are approximately 35 million Americans over the age of 65, and 2 million of them have depression. Elderly adults have the highest rate of suicide in the United States and the elderly suffer more functional impairment as a result of depression than from any other medical condition. Late-life depression can be successfully treated with antidepressants or psychotherapy, yet studies have shown that few elderly adults obtain sufficient treatment in primary care settings. Clearly, there is a critical need to improve the diagnosis and treatment of late-life depression, which meets the mission of the National Institute of Mental Health. Recently, a randomized controlled trial (RCT), Collaborative Care Management of Late Life Depression In The Primary Care Setting?, found that a team-based patient care approach called Improving Mood Promoting Access to Collaborative Treatment? (IMPACT) was highly effective in treating depression among elderly patients in primary care settings. Approximately half of the participants assigned to the IMPACT program experienced a 50 percent or greater reduction in depression symptoms at 12 months, compared with 19 percent of those in usual care. Follow-up studies have demonstrated the effects have been maintained two years after the RCT began and one year after cessation of therapy. The President's New Freedom Commission on Mental Health was created to study the US mental health delivery system and to advise on ways to improve that system. The IMPACT model of care was one of four programs singled out as exemplary by the Commission. The Commission noted that the biggest challenge was "to ensure that the intervention is readily adapted from the research setting into the practice setting" (2004). We propose that an interactive, multi-media training DVD for disseminating the IMPACT model of depression care to primary care clinics is an effective and affordable method for meeting this challenge. In order to demonstrate the feasibility of producing an IMPACT training DVD, a number of specific research aims will be undertaken in Phase I that will (1) Gather formative data from researchers and clinicians with expertise in the IMPACT model to determine the appropriate content for inclusion in the training DVD; (2) Determine the practicality of using DVD for training in the IMPACT model; (3) Develop a sample version of the IMPACT training DVD; (4) Conduct usability and functionality tests of the sample IMPACT training DVD, and (5) Develop the Phase II research design, a randomized trial comparing training using the IMPACT DVD with the current IMPACT training options which include conferences, on- site and telephone consultation and training manuals downloaded from the IMPACT website. One of the stated purposes of the SBIR/STTR program is to increase the commercial application of NIH, CDC and FDA-supported research results. The successful development of an IMPACT training DVD would not only meet that goal but also address a significant health problem in an innovative manner. The development of an effective interactive method for disseminating the IMPACT model of depression care for elderly patients addresses a serious public health problem. This interactive training DVD will be an affordable, easy to implement educational program for health providers in primary care settings. Reducing the high prevalence of depression in the elderly will not only improve the quality of life for those patients but also reduce levels of resource utilization as well.