Excellent depression care need not be expensive

A recent pilot project in Chile has shown that with a little ingenuity quality treatment for debilitating chronic illnesses like depression need not cost more than the health care system or individuals can afford.

American and Chilean physicians worked together to address the plight of depressed, low-income women in Chile by coming up with an intervention system tailored to their financial circumstances and the country's health care system.

These doctors came up with a plan to introduce a depression-treatment program into the government-funded primary health clinics which are the major source of health care for the poor in Chile. Several nurses or social workers at each clinic would receive training to provide group psychotherapy and teach problem-solving skills to depressed women, their progress and act as care managers.

In cases where the depression was persistent or severe, the care manager would consult with a doctor about treatment and when medication was required it would be the less expensive generic varieties rather than name brand drugs.

This pilot project was set up initially under a US government grant to study whether it would be clinically effective. During the test program, 240 women diagnosed with depression were put either into the new program or given the usual care in a primary clinic, which might include medication or a referral for psychiatric assessment.

What the study found was that those in the intervention group did significantly better than those receiving usual care.

Although researchers weren't sure why subjects did better in the intervention group, they think it was due in part to the use of antidepressant medications. These were prescribed more often and used for longer periods within the intervention group. However, researchers adjusted their data to take this into consideration and they still found that women in the intervention group did better, likely because of the group psychotherapy and consistent follow-up.

After gathering the scientific data, researchers compared the costs of running both programs and found that the intervention program only cost $25 more per year to keep a woman depression free.

Now the Chilean government has introduced this depression program into its publicly funded health care system, which services about a third of the population, and for an extra cost of only $25 per depressed person per year, low income individuals can receive excellent, effective care.

Similar programs would likely be comparatively inexpensive to set up in other developing countries and even within Canada and the US, where people already have access to moderately good care. It would not require a complete system overhaul or huge expense to ensure that everyone has access to excellent depression care.

All of this goes to show what a little ingenuity can do to improve the quality of care that regular citizens receive.

Okanagan Clinical Trials currently has several ongoing studies with depression. If you are a depressed adult you may be eligible to participate. All costs are covered by the study and participation does not affect your regular or extended medical coverage. Contact us for more information at 862-8141.


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