Doctors' phone calls can improve depression treatment

BY SONDRA WOLFER
DAILY NEWS WRITER

Sunday, May 11th 2008, 4:00 AM

A medical study of seniors with depression is putting a new spin on that old bromide, "An apple a day keeps the doctor away."

In this case, it could mean just a phone call from the doctor every few days.

The study of older Bronxites with depression has found that just a few extra phone calls can help them get the right doses of medication, lengthen time between hospital stays and reduce medical costs.

The calls could be an affordable way to help these patients get treatment and referrals from their primary care physicians, who are at the front line of depression care in the elderly, said Dr. Gary Kennedy, professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine and director of the division of geriatric psychiatry at Montefiore Medical Center.

Overcoming barriers to depression treatment for the elderly is increasingly important as waves of baby boomers become senior citizens while fewer medical students are specializing in geriatrics with even fewer studying geriatric psychiatry.

The Bronx faces additional hurdles with large low-income populations. They are more likely to experience disabilities earlier in life and less likely to have depression care. The borough also has a large immigrant population with language barriers, as well as high rates of chronic illnesses, such as diabetes and heart disease.

"There's this reciprocity between disabling illness and depression," Kennedy said.

Researchers studied 122 older patients who were recently released from Montefiore Medical Center and found to be depressed during telephone screenings.

"It's like the hospital is calling to say, 'Are you okay?' That's highly appealing to people," he said.

Half the patients received three depression screenings by phone over three months, while the other half received six phone calls from trained facilitators who also provided depression information, answered questions about medication, and offered encouragement and assistance.

While both groups were equally likely to receive anti-depressants, the facilitated group was more likely to receive an adequate dose.

The cost of care for the patients receiving calls averaged $6 less per day and, of the patients who returned to the hospital, those in the facilitated care group stayed out an average of a month longer.

"It may have conveyed a sense of hopefulness. 'Someone's checking on me. Someone cares.' That may have made the difference," Kennedy said.

The facilitated phone calls are an affordable approach, in part, because the callers don't have to be trained to deliver psychotherapy. When severe depression or suicidal risk is determined, the facilitators help the patient access critical treatment.

Though the study was small in scale, Kennedy said the findings indicated that the affordable, simple addition of phone calls could have a profound impact.

"We're trying to translate the science into services," Kennedy said. "We'd like to expand this to the point where depression care facilitation was the standard."