Randomized Controlled Trial of a Collaborative Care Intervention for Mood Disorders by a National Commercial Health Plan

Abstract

Objective: Few individuals with mood disorders have access to evidence-based collaborative chronic care models (CCMs) because most patients are seen in small-group practices (<20 providers) with limited capacity to deliver CCMs. In this single-blind randomized controlled trial, we determined whether a CCM delivered nationally in a U.S. health plan improved 12-month outcomes among enrollees with mood disorders compared with usual care.

Methods: Aetna insurance enrollees (N=238), mostly females (66.1%) with a mean age of 41.1 years, who were recently hospitalized for unipolar major depression or bipolar disorder provided informed consent, completed baseline assessments, and were randomly assigned to usual care or CCM. The CCM included 10 sessions of the Life Goals self-management program and brief contacts by phone by a care manager to determine symptom status. Primary outcomes were changes over 12 months in depression symptoms (nine-item Patient Health Questionnaire [PHQ-9]) and mental health-related quality of life (Short Form-12).

Results: Adjusted mean PHQ-9 scores were lower by 2.34 points (95% confidence level [CL]=-4.18 to -0.50, p=0.01), indicating improved symptoms, and adjusted mean SF-12 mental health scores were higher by 3.21 points (CL=-.97 to 7.38, p=0.10), indicating better quality of life, among participants receiving CCM versus usual care.

Conclusions: Individuals receiving CCM compared with usual care had improved clinical outcomes, although substantial attrition may limit the impact of health plan-level delivery of CCMs. Further research on the use of health plan-level interventions, such as CCMs, as alternatives to practice-based models is warranted.

Trial registration: ClinicalTrials.gov NCT02041962.

Keywords: Bipolar disorder; Care management; Depression; Health maintenance organizations; Health plans; Population health; Primary care.

Figures

Figure 1:. Mean Depression Symptom and Mental Health Quality of Life Scores by Treatment Arm Across Time (N=73).

The first figure enables the reader to see the unadjusted scores of depression symptoms (PHQ-9) by treatment arm across time. Higher scores reflect worse depression symptoms. The second figure enables the reader to see the unadjusted scores of mental health quality of life (SF-12 MCS) treatment arm across time. Higher scores reflect better quality of life.

Figure 1:. Mean Depression Symptom and Mental Health Quality of Life Scores by Treatment Arm Across Time (N=73).

The first figure enables the reader to see the unadjusted scores of depression symptoms (PHQ-9) by treatment arm across time. Higher scores reflect worse depression symptoms. The second figure enables the reader to see the unadjusted scores of mental health quality of life (SF-12 MCS) treatment arm across time. Higher scores reflect better quality of life.