What is telephone care management for depression?

It is structured outreach between visits. In the trial by Simon and colleagues (2004), a care manager made at least 3 phone calls, gave feedback to the treating physician, and helped coordinate care for patients who were starting antidepressant treatment.

Did patients actually answer the calls?

Yes, at a high rate. In the same trial, 97% of patients took part in telephone care management and 93% took part in care management plus phone therapy. That high participation is one of the clearest reasons phone outreach is worth a clinic's attention.

Does a larger care manager program help depression?

In the IMPACT trial led by Jürgen Unützer (2002), older adults who got a depression care manager working with their primary care team were much more likely to cut their symptoms in half at 12 months than those in usual care. Regular care manager contact between visits is a core part of that model.

Integration

Do care manager phone calls between visits help patients with depression?

Short answer

Yes. In a 600-patient randomized trial, adding telephone care management to usual primary care raised the share of patients who rated their depression much improved, from 55% to 66%, and satisfaction from 29% to 47%. Pairing those calls with brief phone therapy helped more, reaching 80% much improved.

The research

Simon, G. E., Ludman, E. J., Tutty, S., Operskalski, B., & Von Korff, M. (2004). Telephone Psychotherapy and Telephone Care Management for Primary Care Patients Starting Antidepressant Treatment: A Randomized Controlled Trial. JAMA, volume 292, issue 8, pages 935 to 942.

Sample 600 patients starting depression treatment in 7 group-model primary care clinics in Seattle, randomized to usual care, usual care plus telephone care management, or care management plus an 8-session telephone therapy program.

Published 2004

Journal JAMA

Gregory Simon and colleagues ran a three-group randomized trial with 600 patients who were just starting depression treatment in 7 group-model primary care clinics in Seattle. One group got usual primary care. A second got usual care plus telephone care management, which meant at least 3 outreach calls, feedback to the treating physician, and help coordinating care. A third got that care management plus a structured 8-session cognitive behavioral therapy program delivered by phone. Trained interviewers who did not know the group checked in at 6 weeks, 3 months, and 6 months. Patients took part at a high rate, 97% for care management and 93% for care management plus phone therapy. Care management on its own had smaller effects: more patients rated their depression much improved (66% versus 55%) and more were very satisfied (47% versus 29%), but its effect on average depression scores was not statistically significant. Adding phone therapy did more, with lower depression scores and 80% versus 55% rating themselves much improved. The authors called for active outreach to patients rather than waiting for them to return on their own.

Read the paper

What does this mean for your clinic?

Start with what the calls actually were, because the plain version is easy to miss. Telephone care management here was not therapy. It was a care manager reaching out between visits: at least 3 calls, a note back to the treating physician, and help coordinating the plan. The question for a practice is whether that low-cost outreach, on its own, changes how patients do.

The honest answer from this trial is that it helps, but modestly. Patients who got the calls were more likely to say their depression was much improved, 66% versus 55%, and far more likely to be very satisfied with their care, 47% versus 29%. Those are real gains in engagement and experience. But on the average symptom score, the trial could not show a clear difference from the calls alone. So care management reached people and kept them in care, yet by itself it did not move the main clinical number.

What did move it was adding structured work to the calls. The arm that paired care management with an 8-session phone therapy program had lower depression scores and the highest rate of feeling much improved, 80%. Read together, the two arms tell a clear story for a clinic: outreach gets patients engaged and satisfied, and giving them something to do on those calls is what turns engagement into symptom change.

The participation numbers are worth your attention too. 97% and 93% of patients took part in the phone programs. For a practice that loses people between visits, that is the headline. A phone call met patients where they were, and almost all of them stayed in contact. Outreach that patients actually accept is the first problem solved, before any clinical effect is possible.

Now the limits, plainly. This was one trial run in a single integrated health system in Seattle, in group-model clinics, with patients who were just starting antidepressant treatment and were not already in psychotherapy. Your caseload may look different, and your usual care is your own. The trial also predates many of today's tools. Treat it as strong evidence that between-visit outreach keeps patients engaged, and as a reminder that the calls work best when they carry real clinical content and a loop back to the prescriber.

The takeaway

Between-visit calls raised how improved and how satisfied patients felt, with very high participation, so outreach is an accessible way to hold onto people.
Calls alone did not clearly move symptom scores. Pairing outreach with structured therapy did.
Decide who makes the calls, what clinical work happens on them, and how the result gets back to the prescribing clinician.

Terms in this page

Between-session support Integration

This is the work Asendar™ was built for: making the work between sessions visible to your team, so a care manager can see who is engaged and who is drifting before the next visit, and each visit opens with context from the week instead of a cold start. See how it fits a collaborative care clinic.

See how Asendar™ works for clinics

Explore more in the Integration pillar