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Medicare home care program benefited patients with moderate, severe depression

Patients with moderate to severe depression experienced limited but greater benefits than patients with mild disease from a Medicare home depression care management system effectively incorporated into routine practice, according to recent trial findings.

Researchers randomly assigned 178 home health nurses from six agencies to 12 Depression Care for Patients at Home (Depression CAREPATH) intervention teams or nine control “enhanced usual care” teams. The researchers then enrolled 306 patients (mean age, 76.5 years; 69.6% women) classified with depression, based on a health screening, in the Medicare Home Health program. Follow-up occurred at 3, 6, and 12 months. A scale score determined depression severity.

In the full sample of patients, the Depression CAREPATH intervention did not have any effect, nor did it yield any effect in the subgroup of patients categorized as having mild depression (depression score less than 10). In these patients, there were no significant changes in depression scores at any follow-up time point.

Among the 208 patients whose depression scores indicated moderate to-severe depression (score of 10 or greater), however, the Depression CAREPATH intervention yielded reductions at 3 months (14.1 vs. 16.1; P=.04), 6 months (12 vs. 14.7; P=.02) and 12 months (11.8 vs. 15.7; P=.005).

According to the researchers, these findings suggested that a home health depression program can be implemented and provide some improvements to patients with greater depression scores.

“Medicare recommends depression screening and intervention, but the clinical needs of home health care patients, the scarcity of mental health specialists, and the structure and practice of home health care pose challenges to this goal,” the researchers wrote. “This effectiveness trial demonstrates that home health care nurses can effectively integrate depression care management into routine practice, with the clinical benefit to moderate to severely depressed patients extending beyond the home health care service period.”

Disclosure: See the study for a full list of relevant financial disclosures.