Disease management for depression in an MS clinic

Area of Science:

• Neurology
• Psychiatry
• Healthcare Management

Background:

• Depression is common in multiple sclerosis (MS), with available evidence-based treatments facing implementation challenges.
• Existing disease management strategies for depression, successful in primary care, geriatrics, and diabetes, may need adaptation for MS clinics.

Purpose of the Study:

• To explore the feasibility and effectiveness of implementing a disease management program specifically for depression within a multiple sclerosis (MS) clinic setting.
• To assess the impact of a structured disease management intervention on depression rates, quality of life, and functional status in MS patients.

Main Methods:

• A non-randomized 'before-after' study design was employed at the University of Calgary MS Clinic.
• Patients were screened for depression using the Center for Epidemiologic Studies Depression Rating Scale (CES-D).
• During the intervention phase, positive screens triggered case manager notification and an offer of disease management; outcomes (major depression via MINI, EQ-5D, WHO DAS II) were assessed six months later.

Main Results:

• Eighty-three patients were enrolled; 54 received disease management and 29 received treatment as usual.
• A lower frequency of major depression was observed in the disease management group six months post-screening.
• No significant differences in quality of life (EQ-5D) or functional status (WHO DAS II) were detected between groups.

Conclusions:

• The disease management intervention for depression demonstrated effectiveness among those who participated.
• Adaptation of primary care disease management strategies may be necessary for successful implementation in MS clinics.
• Lower-than-expected participation rates and higher baseline treatment rates limited the intervention's impact on the overall target population.