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Online CBT and care managers effective against depression in primary care


New research shows that Internet CBT for depression is a well-functioning method in primary care. There is also evidence that involving a care manager in depression care, giving patients frequent, reliable guidance, both improves patients’ health and is highly cost-effective.

“For patients with depression, accessing care and getting continuity and coordination in care services are crucial,” says Anna Holst of Sahlgrenska Academy, University of Gothenburg. She has a PhD in medicine and is employed as a specialist physician and head of a Närhälsan primary care center (the public primary care provider in the Region Västra Götaland) in Gothenburg.

In her thesis work, Holst studied the cost-effectiveness of, first, cognitive behavioral therapy (CBT) mediated online and, second, a collaborative care organization with a care manager at the primary care center. This position is held by a specially trained nurse who continuously monitors and supports people with depression, steers them through the system and ensures that care measures are implemented.

Internet CBT proved to be a good alternative to the conventional depression treatment in primary care, and just as cost-effective. To many patients, the freedom of being able to receive therapy when and where they wanted was attractive.

Many winners from care managing

The results also showed that depression patients’ contact with a care manager is a sound method, enabling them to recover more rapidly and return to work significantly earlier. The fact that, compared with conventional primary care, implementing organized care managing is also highly cost-effective for healthcare services and society is a key finding.

The basis for Holst’s research comprised nearly 400 patients with mild to moderate depression. Those in contact with a care manager not only regained their health faster; more patients in this category also recovered fully and a higher proportion returned to work earlier. Together, these factors contribute to the high cost-effectiveness of organized care managing in primary care.

“These results are exciting and can serve as the foundation for decision-making about depression care, which in fact makes up a large share of the health care provided in Sweden today, since depression is so extensive. A huge number of Swedes are affected by depression, either personally or as family members,” Holst says.

Research with potential for influence

Cecilia Björkelund, senior professor in general practice at Sahlgrenska Academy, University of Gothenburg, emphasizes the value of evidence-based research on how organization and methods in the pressured primary care sector can be developed:

“Depression is a major challenge to primary care. Continuity and accessibility for people who are affected are especially important. And in those respects, care works poorly today. After the initial visit to the doctor, a patient may have to wait for months before meeting a psychologist or therapist. During the waiting, the health center isn’t always in regular contact with the patient. Being on the waiting list doesn’t constitute good care — in fact, it’s no care at all.”

Title: Aspects of cost-effectiveness and feasibility of implementations for care of depressed persons in primary care — internet-based treatment and care manager organization

Contacts: Anna Holst and Cecilia Björkelund

Images: Collage (photo: Mattonstock) and portrat pictures of Anna Holst (photo: Thomas Harrysson) and  Cecilia Björkelund (photo: Christina Ylander)