Time to remission for depression with collaborative care management (CCM) in primary care

Background: collaborative care management (ccm) has been shown to have superior outcomes to usual care (uc) for depressed patients with a fixed end point. this study was a survival analysis over time comparing ccm with uc using remission (9-item patient health questionnaire [phq-9] score <5) and persistent depressive symptoms (pdss; phq-9 score >10) as end points. methods: a retrospective cohort study of 7340 patients with depression cared for at 4 outpatient primary care clinics was conducted from march 2008 through june 2013. all adult patients diagnosed with depression (international classification of diseases,9th revision [icd-9],codes 296.2-3) or dysthymia (icd-9 code 300.4) with an initial phq-9 score >10 were included. ccm was implemented at all clinics between 2008 and 2010. kaplan-meyer survival curves for time to remission and pdss were plotted. a cox proportional hazards model was used to adjust for expected differences between patients choosing ccm versus uc. results: median time to remission was 86 days (95% confidence interval [ci],81-91 days) for the ccm group versus 614 days (95% ci,565-692 days) for the uc group. likewise,median duration of pdss was 31 days (95% ci,30-33 days) for the ccm group versus 154 days (95% ci,138-182 days) for the uc group. in the cox proportional hazards model,which controlled for covariates such as age,sex,race,diagnosis,and initial phq-9 score,ccm was associated with faster remission (hazard ratio of the ccm group [hrccm],2.48; 95% ci,2.31-2.65). conclusions: this study demonstrated that patients enrolled in ccm have a faster rate of remission and a shorter duration of pdss than patients choosing uc.