Linda H. Harpole

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CONTEXT Depression is a leading cause of functional impairment in elderly individuals and is associated with high medical costs, but there are large gaps in quality of treatment in primary care. OBJECTIVE To determine the incremental cost-effectiveness of the Improving Mood Promoting Access to Collaborative Treatment (IMPACT) collaborative care management(More)
OBJECTIVE This study describes physicians' satisfaction with care for patients with depression before and after the implementation of a primary care-based collaborative care program. METHOD Project Improving Mood, Promoting Access to Collaborative Treatment for late-life depression (IMPACT) is a multisite, randomized controlled trial comparing a primary(More)
OBJECTIVE To determine the long term effectiveness of collaborative care management for depression in late life. DESIGN Two arm, randomised, clinical trial; intervention one year and follow-up two years. SETTING 18 primary care clinics in eight US healthcare organisations. Patients 1801 primary care patients aged 60 and older with major depression,(More)
OBJECTIVE Inappropriate utilization of diagnostic testing has been well documented. The purpose of this study was to measure the impact of presenting real time, evidence-based critiques about the appropriateness of abdominal radiograph (KUB) orders on physician decision making. DESIGN Prospective trial where evidence-based critiques were presented to(More)
BACKGROUND Depression is common in older adults and often coexists with multiple chronic diseases, which may complicate its diagnosis and treatment. OBJECTIVE To determine whether or not the presence of multiple comorbid medical illnesses affects patient response to a multidisciplinary depression treatment program. DESIGN, SETTING AND PARTICIPANTS(More)
BACKGROUND Depression frequently occurs in combination with diabetes mellitus, adversely affecting the course of illness. OBJECTIVE To determine whether enhancing care for depression improves affective and diabetic outcomes in older adults with diabetes and depression. DESIGN Preplanned subgroup analysis of the Improving Mood-Promoting Access to(More)
OBJECTIVE Although estrogens are thought to have a beneficial effect on menopausal symptoms, the role of estrogen in the etiology and treatment of depression in older women remains unclear. The authors examined the relationship between hormone therapy (HT) use and depressive symptom severity. METHODS Authors report the findings from a cross-sectional(More)
groups and semi-structured individual interviews with all Depression Clinical Specialists (DCSs) working with Project IMPACT (Improving Mood: Promoting Access to Collaborative Treatment), a study testing a collaborative care intervention for late life depression, to examine integration of the intervention model into primary care. DCSs described key(More)
We describe the daily work activities of 13 Depression Clinical Specialists (DCSs) at 7 national sites who served as care managers in an effective multisite randomized trial of a disease management model for depression in primary care. DCSs carried portable random-reminder beepers for a total of 147 consecutive workdays and recorded 4,030 work activities.(More)
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