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The Bypassing the Blues Trial Telephone-Delivered Collaborative Care for Treating Post-CABG Depression

The Bypassing the Blues Trial Telephone-Delivered Collaborative Care for Treating Post-CABG Depression. BL Rollman, B Herbeck Belnap, PR Houck, S Mazumdar, PJ Counihan, HC Schulberg, WN Kapoor, CF Reynolds III University of Pittsburgh School of Medicine. All work supported by R01 HL70000.

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The Bypassing the Blues Trial Telephone-Delivered Collaborative Care for Treating Post-CABG Depression

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  1. The Bypassing the Blues Trial Telephone-Delivered Collaborative Care for Treating Post-CABG Depression BL Rollman, B Herbeck Belnap, PR Houck, S Mazumdar, PJ Counihan, HC Schulberg, WN Kapoor, CF Reynolds III University of Pittsburgh School of Medicine All work supported by R01 HL70000

  2. Presenter Disclosure Information • Bruce L. Rollman, MD, MPHThe Bypassing the Blues Trial Grant support: NHLBI R01 HL70000 Other research support: NIMH Speakers bureau/honoraria/advisory board/ownership interest: None

  3. CABG Surgery • ~450,000 / Yr. performed in U.S. • Indications: • Improve health-related quality of life (HRQoL) • Decrease angina • Improve survival • 20-25% Elevated mood symptoms • Mood symptoms associated with: • Delayed recovery • ↑Readmissions, C-V events, and death

  4. Bypassing the BluesSpecific Aims Can collaborative care for depression: Increase: HRQoL (SF-36 MCS - primary outcome) Physical functioning (SF-36 PCS, DASI) Decrease: Mood symptoms (HRS-D) Health care utilization (Rehospitalization) Health care costs ($$)

  5. Bypassing the BluesStudy Design Rollman BL, et al. Psychosomatic Med. 2009; 71:217-30

  6. 7 Pittsburgh- Area Hospitals Jefferson Regional Mercy Hospital UPMC-Passavant UPMC-Presbyterian UPMC-Shadyside Westmoreland West Penn Hospital

  7. Screening Summary3/04-9/07

  8. Sociodemographics

  9. Collaborative Care (CC)3/04 – 5/08 Nurse phoned patient at regular intervals X 8 mo. • Provide basic psychoeducation • Assess treatment preferences: • Self-management workbook • Antidepressant pharmacotherapy • Mental health specialty referral • Monitor treatment response & suggest changes Weekly case review with study PCP/psychiatrist Nurse feedback to patient’s PCP Rollman BL, et al. Psychosomatic Med. 2009; 71:217-30

  10. CC Increases HRQoL (Primary Outcome) ES: 0.30 (0.17-0.52; P=0.01) Rollman BL, et al. JAMA. 2009; 302:2095-2103

  11. CC Decreases Mood Sx. ES: 0.30 (0.08-0.53; P=0.009) Rollman BL, et al. JAMA. 2009; 302:2095-2103

  12. Differential Impact by Gender SF-36 MCS (1’ Outcome) All: 0.30 (0.17-0.52) P=0.01 Male: 0.53 (0.23-0.84) P<0.001 Female: 0.08 (-0.28-0.43) P=0.68 HRS-D All: 0.30 (0.08-0.53) P=0.009 Male: 0.39 (0.09-0.69) P=0.01 Female: 0.23 (-0.13-0.59) P=0.20 SF-36 PCS All: 0.26 (0.03-0.48) P=0.03 Male: 0.57 (0.26-0.87) P<0.001 Female: -0.04 (-0.40-0.31) P=0.82 DASI All: 0.32 (0.09-0.54) P=0.006 Male: 0.55 (0.24-0.85) P<0.001 Female: 0.10 (-0.25-0.46) P=0.58 Rollman BL, et al. JAMA. 2009; 302:2095-2103

  13. C-V Rehospitalization: Men 13% Intervention vs. 23% UC; P=0.07 Rollman BL, et al. JAMA. 2009; 302:2095-2103

  14. Limitations • HIPAA • One U.S. region • Cost data presently unavailable • Grant-supported care team • Underpowered for C-V events, mortality

  15. Conclusions • Compared to “usual care” for post-CABG depression at 8-month f/u, telephone-delivered collaborative care improves: • • Mental HRQoL • • Physical functioning • • Mood symptoms Rollman BL, et al. JAMA. 2009; 302:2095-2103

  16. www.bypassingtheblues.pitt.edu

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