Biomedical subjects

David J Katzelnick

Publications and source records attributed to David J Katzelnick.

6 recordsLinked to original sources

PubMed2006

Double-disease management or one care manager for two chronic conditions: pilot feasibility study of nurse telephonic disease management for depression and congestive heart failure.

This study assessed the feasibility of a telephonic nurse double-disease management program (DDMP) for patients with depression and congestive heart failure. Thirty-five patients with depression and congestive heart failure were entered into a novel DDMP modeled after Wagner's chronic illness care model and implemented as part of a 13-month Breakthrough Series Collaborative administered by the Institute of Healthcare Improvement. Twenty-four patients remained in the program long enough to complete at least one follow-up assessment (ie, 6 weeks or longer). Patients were entered into the program based on depression severity scores from either the interactive voice response (IVR) version of the Hospital Anxiety and Depression Scale (HADS) or the self-administered (or telephonic) Patient Health Questionnaire (PHQ). Because use of the IVR version of the HADS was eliminated after several weeks into the program (because of poor patient acceptance), 19 patients had both entry and follow-up scores on the same instrument (PHQ). Depression "response" was defined as a 50% improvement in PHQ score. Mixed models regression was used to test the statistical significance of change in PHQ scores over time. Patient and clinician reports were obtained to evaluate program acceptability and satisfaction. Eighty-two percent of patients (n = 11) with Major Depressive Disorder (MDD) responded, and 75% of patients (n = 8) with "other depression" (PHQ score < 10) responded. Mean change in PHQ scores for the sample as a whole improved significantly over the 24 weeks of the program (p < 0.0003), as well as for those with major depression and other depression considered separately (p < 0.01 for both). In some patients who refused medication, depression seemed to respond to self-management support interventions of the care manager. Based on patient acceptance and clinicians' reports, the program appeared feasible and possibly effective. DDMP appears feasible and possibly effective. Future clinical trials are warranted.

Aged↗

PubMed2005

Validation of an IVRS version of the MADRS.

Interest in self-reported measures of depression in clinical trials has grown in recent years. This study compared the reliability and validity of the clinician-administered Montgomery-Asberg Depression Rating Scale (MADRS) to a computer-administered version administered over the telephone using Interactive Voice Response (IVR) technology. Sixty subjects were administered both the clinician- and computer-administered versions of the MADRS in a counter-balanced order. A subsample of 20 patients was reassessed 24h later by both methods. Mean score differences between IVR and clinician were not statistically significant (<1 point) and a high correlation was found between forms (r=.815, p<.001). Reliability measures (Cronbach's Alpha and 24-h test-retest) were comparable. Clinicians rated the severity of subjects' sadness and pessimistic thoughts lower than subjects self-report. The data obtained in this pilot study provide support for the equivalence between the clinician and IVR versions of the MADRS.

Adult↗

PubMed2005

Applying depression-specific change concepts in a collaborative breakthrough series.

BACKGROUND: Twenty ethnically and geographically diverse health care organizations, including 15 Bureau of Primary Health Care centers, participated in an Institute for Healthcare Improvement (IHI) collaborative Breakthrough Series (BTS) project on depression. Teams attended three learning sessions that emphasized the chronic illness care model, key depression change concepts, and how to initiate plan-do-study-act cycles. RESULTS: Seventeen of the 20 organizations completing the BTS achieved a faculty assessment of at least a 4 (5 indicates significant improvement). More than 2000 patients initiated depression treatment and were registered in the plan's depression registries. Patients in the centers who used the recommended measures had the following outcomes: 56% had significant change in their depressive symptoms at 12 weeks, 87% completed follow-up assessments, 54% continued antidepressant medication for at least 10 weeks, and 90% completed a structured diagnostic assessment before treatment. DISCUSSION: On the basis of the feedback from ten successful teams, the essential change concepts for depression were establishing and maintaining a patient registry, care coordination, diagnostic assessment, and proactive follow-up. Many of the BTS centers have continued to expand their depression treatment programs. The IHI BTS appears to be a viable method of disseminating evidence-based depression care.

Case Management↗

PubMed2005

Prevalence and burden of illness of migraine in managed care patients.

OBJECTIVE: To determine the 3-month prevalence rate of migraine in a health maintenance organization (HMO) population, using a 2-stage screening process and neurologist exam, and to examine the burden of illness associated with both previously diagnosed and previously undiagnosed migraine in this population METHODS: A migraine assessment was sent to a random sample of 1,000 HMO patients between April 1999 and January 2000. Those screening positive and a random sample of those screening negative for migraine were evaluated by neurologists using a structured diagnostic assessment. Then, those diagnosed to have migraines by the study's neurologists completed a battery of 3 questionnaires, evaluating severity, distress, and impairment RESULTS: Of 1,000 questionnaires sent, 753 (75.3%) were returned. The estimate of prevalence of migraine in this population ranged from 21.4% (adjusted for response bias) to 27.8% (unadjusted for selection bias). Only 48% of respondents had been previously diagnosed with migraine. The typical migraine caused moderate-to-severe distress in 69%, and 66% had definite or extreme interference in their social or occupational functioning. The average migraineur missed 7.6 hours of work due to migraine in the past 3 months. Previously undiagnosed migraine was associated with substantial impairment, with 58% of responders reporting interference with daily activities and 54% reporting moderate or greater distress. There was no significant difference between previously diagnosed and undiagnosed migraineurs on 3 outcome measures: pain, interference, or days of missed work. A higher proportion of previously diagnosed migraineurs (84%) reported moderate or greater distress compared with undiagnosed migraineurs (54%, P=0.002). CONCLUSIONS: Using a neurologist exam, the researchers found that the prevalence of migraine headaches was higher than previously reported. About one half of migraineurs had been previously undiagnosed. Undiagnosed migraine is associated with significant pain, distress, and dysfunction and is similar in these respects to diagnosed migraine. Increased public education and physician education on migraine are warranted.

Adult↗

PubMed2002

Fluoxetine in social phobia: a double-blind, placebo-controlled pilot study.

The objective of the study was to examine the efficacy of fluoxetine in social phobia. Sixty subjects were randomly assigned to 14 weeks of double-blind therapy with either fluoxetine or placebo. Dose was fixed at 20 mg for fluoxetine during the first 8 weeks of double-blind treatment; during the final 6 weeks, the dose could be increased every two weeks by 20 mg to a maximum of 60 mg/day. An intentto-treat analysis was used. A significant change from baseline to endpoint was found for both fluoxetine and placebo on the Liebowitz Social Anxiety Scale. However, no significant difference was found between fluoxetine and placebo. The change for fluoxetine was somewhat lower than that found with other selective serotonin reuptake inhibitors, whereas the placebo response was greater. Fluoxetine failed to separate from placebo in this trial. It is unknown whether a larger dose for longer duration would have yielded separation from placebo. A higher than usual placebo response rate was found.

Adolescent↗

PubMed2002

Antidepressant medication management and Health Plan Employer Data Information Set (HEDIS) criteria: reasons for nonadherence.

BACKGROUND: While nationwide data have found that many patients do not meet the National Committee for Quality Assurance uniform standards for successful antidepressant treatment, reasons for this failure are not well understood. We examined the reasons for this failure through a systematic chart review. METHOD: A chart review was conducted on a random sample of 249 health maintenance organization patients who failed 1 or more of the 3 Health Plan Employer Data Information Set criteria (i.e., 3 follow-up visits or adequate duration of acute or continuation phase treatment). RESULTS: The most common reason for visits failure (N = 192) was that the patient restarted a previously prescribed successful antidepressant (N = 30, 16%). In 23 patients (12%), the patient had a visit with the prescribing provider, but mental health was not coded or documented in the case notes. Twenty-one percent (N = 40) were misclassified as not having 3 visits. The most common reasons for misclassification were mental health was discussed but not coded (N = 16, 8%) and wrong start dates due to use of medication samples (N = 10, 5%). Patient nonadherence was the most common reason for failure to meet adequate acute (N = 109) and continuation (N = 99) phase duration of treatment (13% and 24%, respectively); only 9% stopped taking medication in the acute phase due to side effects. Twenty-five percent of patients had told their doctor they were taking their medication while the pharmacy database found they were not. CONCLUSION: A large discrepancy between patients' actual and reported compliance was found and may in part account for physicians' inability to detect and thus address this issue. Patients' restarting a previous medication is common and warrants discussion regarding differential need for visit frequency.

Adolescent↗