Enid M. Hunkeler

Bio: Enid M. Hunkeler is an academic researcher from Kaiser Permanente. The author has contributed to research in topics: Health care & Depression (differential diagnoses). The author has an hindex of 44, co-authored 72 publications receiving 10074 citations. Previous affiliations of Enid M. Hunkeler include University of Washington & University of California, San Francisco.

Collaborative Care Management of Late-Life Depression in the Primary Care Setting: A Randomized Controlled Trial

Abstract: ContextFew depressed older adults receive effective treatment in primary care settings.ObjectiveTo determine the effectiveness of the Improving Mood–Promoting Access to Collaborative Treatment (IMPACT) collaborative care management program for late-life depression.DesignRandomized controlled trial with recruitment from July 1999 to August 2001.SettingEighteen primary care clinics from 8 health care organizations in 5 states.ParticipantsA total of 1801 patients aged 60 years or older with major depression (17%), dysthymic disorder (30%), or both (53%).InterventionPatients were randomly assigned to the IMPACT intervention (n = 906) or to usual care (n = 895). Intervention patients had access for up to 12 months to a depression care manager who was supervised by a psychiatrist and a primary care expert and who offered education, care management, and support of antidepressant management by the patient's primary care physician or a brief psychotherapy for depresssion, Problem Solving Treatment in Primary Care.Main Outcome MeasuresAssessments at baseline and at 3, 6, and 12 months for depression, depression treatments, satisfaction with care, functional impairment, and quality of life.ResultsAt 12 months, 45% of intervention patients had a 50% or greater reduction in depressive symptoms from baseline compared with 19% of usual care participants (odds ratio [OR], 3.45; 95% confidence interval [CI], 2.71-4.38; P<.001). Intervention patients also experienced greater rates of depression treatment (OR, 2.98; 95% CI, 2.34-3.79; P<.001), more satisfaction with depression care (OR, 3.38; 95% CI, 2.66-4.30; P<.001), lower depression severity (range, 0-4; between-group difference, −0.4; 95% CI, −0.46 to −0.33; P<.001), less functional impairment (range, 0-10; between-group difference, −0.91; 95% CI, −1.19 to −0.64; P<.001), and greater quality of life (range, 0-10; between-group difference, 0.56; 95% CI, 0.32-0.79; P<.001) than participants assigned to the usual care group.ConclusionThe IMPACT collaborative care model appears to be feasible and significantly more effective than usual care for depression in a wide range of primary care practices.

Efficacy of nurse telehealth care and peer support in augmenting treatment of depression in primary care.

Abstract: Background Primary care treatment of depression needs improvement. Objective To evaluate the efficacy of 2 augmentations to antidepressant drug treatment. Design Randomized trial comparing usual care, telehealth care, and telehealth care plus peer support; assessments were conducted at baseline, 6 weeks, and 6 months. Setting Two managed care adult primary care clinics. Participants A total of 302 patients starting antidepressant drug therapy. Interventions For telehealth care: emotional support and focused behavioral interventions in ten 6-minute calls during 4 months by primary care nurses; and for peer support: telephone and in-person supportive contacts by trained health plan members recovered from depression. Main outcome measures For depression: the Hamilton Depression Rating Scale and the Beck Depression Inventory; and for mental and physical functioning: the SF-12 Mental and Physical Composite Scales and treatment satisfaction. Results Nurse-based telehealth patients with or without peer support more often experienced 50% improvement on the Hamilton Depression Rating Scale at 6 weeks (50% vs 37%; P =.01) and 6 months (57% vs 38%; P =.003) and on the Beck Depression Inventory at 6 months (48% vs 37%; P =. 05) and greater quantitative reduction in symptom scores on the Hamilton scale at 6 months (10.38 vs 8.12; P =.006). Telehealth care improved mental functioning at 6 weeks (47.07 vs 42.64; P =.004) and treatment satisfaction at 6 weeks (4.41 vs 4.17; P =.004) and 6 months (4.20 vs 3.94; P =.001). Adding peer support to telehealth care did not improve the primary outcomes. Conclusion Nurse telehealth care improves clinical outcomes of antidepressant drug treatment and patient satisfaction and fits well within busy primary care settings.

Comorbid depression, chronic pain, and disability in primary care.

Abstract: Objectives: The objectives of this study were to provide estimates of the prevalence and strength of association between major depression and chronic pain in a primary care population and to examine the clinical burden associated with the two conditions, singly and together. Methods: A random sample of Kaiser Permanente patients who visited a primary care clinic was mailed a questionnaire assessing major depressive disorder (MDD), chronic pain, pain-related disability, somatic symptom severity, panic disorder, other anxiety, probable alcohol abuse, and health-related quality of life (HRQL). Instruments included the Patient Health Questionnaire, SF-8, and Graded Chronic Pain Questionnaire. A total of 5808 patients responded (54% of those eligible to participate). Results: Among those with MDD, a significantly higher proportion reported chronic (i.e., nondisabling or disabling) pain than those without MDD (66% versus 43%, respectively). Disabling chronic pain was present in 41% of those with MDD versus 10% of those without MDD. Respondents with comorbid depression and disabling chronic pain had significantly poorer HRQL, greater somatic symptom severity, and higher prevalence of panic disorder than other respondents. The prevalence of probable alcohol abuse/dependence was significantly higher among persons with MDD compared with individuals without MDD regardless of pain or disability level. Compared with participants without MDD, the prevalence of other anxiety among those with MDD was more than sixfold greater regardless of pain or disability level. Conclusions: Chronic pain is common among those with MDD. Comorbid MDD and disabling chronic pain are associated with greater clinical burden than MDD alone. Key words: major depression, chronic pain, comorbidity, disability, epidemiologic comorbidity. MDD major depressive disorder; HRQL health-related quality of life; HMO health maintenance organization; PHQ Patient Health Questionnaire; GCPS Graded Chronic Pain Scale; CP chronic pain; DCP disabling chronic pain; GAD generalized anxiety disorder; SCID Structured Clinical Interview for DSM-III-R; PRIME-MD Primary Care Evaluation of Mental Disorders; CI confidence interval; DSM-IV Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; DSM-III-R Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised.

Suicide risk in bipolar disorder during treatment with lithium and divalproex.

Abstract: IPOLAR DISORDER IS A MAJOR public health problem, in any given year affecting approximately 1.3% to 1.5% of the US population. 1 In addition to the personal anguish of affected individuals, bipolardisorderplacessubstantialburdens on the health care, social welfare, and criminal justice systems and on families, caregivers, and employers. In the World Health Organization’s Global Burden of Disease study, bipolardisorderrankedsixthamongall medicaldisordersinyearsoflifelostto death or disability. 2 Suicide and suicide attempts are significant contributorstothatprematuremortalityanddisability. Estimates of the lifetime risk of suicide in patients with bipolar disorder range from 8% to 20%, 10 to 20 times that in the US general population. 3-7 Inareviewof31studiesincluding nearly 10000 patients with recurrent affective disorder (primarily bipolar), the proportion of deaths attributabletosuiciderangedfrom9%to 60%, with a weighted mean of 18.9%. 8 Thus,itiscriticaltodetermineifmaintenance treatment is associated with a reduction in suicide attempts and suicide mortality in this high-risk group. Although a number of moodstabilizingdrugsarecommonlyusedin the long-term management of bipolar disorder, lithium and the anticonvulsant lamotrigine are the only drugs for which long-term efficacy has been

Health Care Contacts in the Year Before Suicide Death

Abstract: BACKGROUND Suicide prevention is a public health priority, but no data on the health care individuals receive prior to death are available from large representative United States population samples.

The PHQ-9: validity of a brief depression severity measure.

Abstract: OBJECTIVE: While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity.

Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization

Abstract: Background End-stage renal disease substantially increases the risks of death, cardiovascular disease, and use of specialized health care, but the effects of less severe kidney dysfunction on these outcomes are less well defined. Methods We estimated the longitudinal glomerular filtration rate (GFR) among 1,120,295 adults within a large, integrated system of health care delivery in whom serum creatinine had been measured between 1996 and 2000 and who had not undergone dialysis or kidney transplantation. We examined the multivariable association between the estimated GFR and the risks of death, cardiovascular events, and hospitalization. Results The median follow-up was 2.84 years, the mean age was 52 years, and 55 percent of the group were women. After adjustment, the risk of death increased as the GFR decreased below 60 ml per minute per 1.73 m2 of body-surface area: the adjusted hazard ratio for death was 1.2 with an estimated GFR of 45 to 59 ml per minute per 1.73 m2 (95 percent confidence interval, 1....

2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Abstract: Since 1980, the American College of Cardiology (ACC) and American Heart Association (AHA) have translated scientific evidence into clinical practice guidelines (guidelines) with recommendations to improve cardiovascular health. In 2013, the National Heart, Lung, and Blood Institute (NHLBI) Advisory

The PHQ-9: A new depression diagnostic and severity measure

Abstract: and treatable mental disorders presenting in general medical as well as specialty settings. There are a number of case-finding instruments for detecting depression in primary care, ranging from 2 to 28 items.1,2 Typically these can be scored as continuous measures of depression severity and also have established cutpoints above which the probability of major depression is substantially increased. Scores on these various measures tend to be highly correlated3, with little evidence that one measure is superior to any other.1,2,4