Providers

IMPACT is the largest treatment trial for depression ever conducted in the United States. Results from the IMPACT trial show that the IMPACT model of care is twice as effective as usual care in reducing symptoms of depression and that it is robust in a wide variety of clinical settings.

Primary care providers who participated in the IMPACT trial reported that the program substantially improved both their satisfaction with treating late-life depression in primary care and their patients' clinical outcomes (abstract). The IMPACT Implementation Center provides a range of resources to clinicians who are interested in the model.

What providers say about IMPACT

Donald E. Potter, MD is a primary care physician at Group Health Cooperative in Seattle and one of the physicians who participated in the IMPACT study. He spoke about his experiences with the IMPACT trial, “I think there are certain things we don’t talk about in this society, and depression has been one of them. In the past, a lot of patients would mostly talk about their physical problems and then, near the end of the interview, would say oh by the way I’m not sleeping or I’m depressed or my husband or wife think I’m depressed. Now, when patients come in, the nurses are more attuned to depression, and we give them this survey questionnaire to fill out so it’s on the agenda rather than part of the hidden agenda. Hopefully, I was practicing good medicine and addressing depression in the past….The IMPACT patients who have been treated for depression complain of physical symptoms less, I need to see them less, and I can address their physical issues more directly when I do.”*

Cora Hartwell, RN, MSN, ANP was a Depression Care Manager at the Indiana University Regenstrief Institute for Health Care in Indianapolis during the IMPACT study. Cora had 30 years of nursing experience before working with the IMPACT study but had never done any psychosocial nursing. She is a great example of a medical nurse who learned the skills necessary to treat patients with depression and comorbid medical illnesses. About her experiences with the IMPACT study Cora said, “The biggest problem in any patient population is to get people to take their medication. For example, I spent a lot of time with Fanny, over 70, who had very bad pulmonary disease, was taking anywhere from 10 to 18 pills a day, couldn’t read, had poor eyesight and didn’t know how to pull things together. One of her biggest problems was getting her meds straightened out and making sure she was taking them in the right order. If she took them, a lot of her symptoms disappeared. After collaborating with a pharmacist who worked with her using visual clues, we were able to get her to take her medications as ordered and at doses that were beneficial for her. Her emergency room visits decreased, as did her hospital visits, and her quality of life definitely improved. We used the PST-PC process to figure out how to find someone in her family to help her organize her meds, and get her to the clinic so she could keep her appointments. Seeing Fanny emerge from her depression was very rewarding.”*

* Originally published in the 2002 John A. Hartford Foundation annual report. Used with permission.