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Care managers at primary health care centers provide faster recovery from depression

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Earlier return to work and faster recovery for patients with depression - that is the result of the care manager role at health care centers that researchers at Sahlgrenska Academy have developed jointly with the Västra Götaland region’s primary health care.

“Psychiatric illness is a major challenge for primary health care,” says Cecilia Björkelund, senior professor in general medicine at Sahlgrenska Academy, University of Gothenburg. “For those affected, continuity is especially important, and that is insufficient today. After the first doctor’s visit, a patient may have to wait for months to see a psychologist or therapist. During the waiting period, health care centers do not always have regular contact with the patient. Being on the waiting list is not good care; rather it’s non-care.”

Following individuals during the course of the disease

The project involves investigating the role special care managers can play at the health care center for people seeking treatment for depression, anxiety and stress-related illness. The care managers usually are district nurses who devote part of their position to following the individual throughout the course of the disease. After an initial physical meeting, the care manager keeps in touch with the patient through weekly phone calls. The task involves finding out how the patient is feeling, drawing up a care plan with the patient and, if necessary, planning extra visits with the doctor or therapist.

“Above all, it’s about providing support and demonstrating that the caregiver is concerned, but it’s also about using primary health care resources more effectively. In addition, knowing that someone is keeping track of how the patient is doing provides support for the doctors,” Cecilia says.

Mild to moderate depression

The scientific study, whose results were published in the journal BMC Family Practice, is the first study in Sweden showing that the care manager role at the health care center can provide better quality of care in the form of high availability and high continuity for patients with depression.

The study encompasses nearly 400 patients with mild to moderate depression. The patients who had contact with the care manager recovered faster, and this group also became healthier. They returned to work significantly earlier than the group of patients receiving regular care.

“At the health care centers that have introduced care managers, both doctors and health care center managers are pleased, and so are the patients. Most patients who did not have access to a care manager also recovered and were relatively satisfied with their health care, but for the patients in contact with care managers throughout the entire course of the disease, this meant an earlier return to work and even faster recovery,” says Cecilia Björkelund.

The study compared 11 health care centers that introduced the care manager role with 12 other health care centers that offered the care usually given to patients with depression in primary health care today. Nineteen health care centers in the Västra Götaland region and another four in the Dalarna region participated in the project, which was the first part of the method development of primary health care’s organization for Common mental Disorders. Primary health care in Västra Götaland has continued to develop this function. It has now been introduced in about a hundred health care centers, which is half the total number of health care centers in the region.

The study has been conducted in close collaboration between the Unit of Primary Health Care at the University of Gothenburg and Västra Götaland region’s primary health care organisation. Funding has been provided by the Västra Götaland health care and medical services board.

The results were published in the scientific journal BMC Family Practice.

Contact: Cecilia Björkelund

Care manager for psychiatric illness in Region Västra Götaland (in Swedish)