Track 1: Practice Guidelines and Treatment Strategies
Track 2: Health System and Patient Management Strategies

• Release date: December 15, 2011
• Expiration date: June 15, 2013
• Estimated time to complete activity: 1.0 hours for Track 1 and 1.0 hours for Track 2
• Compatible with IE 6 and up, Firefox, Safari

Target Audience

This activity has been designed to meet the educational needs of:

• Psychiatrists, primary care physicians, and other clinicians involved with the care of adult patients with major depressive disorder (MDD)
• Medical Directors and Pharmacy Directors from health plans, HMOs, integrated health systems, employers, quality organizations, public payer groups, and other managed care organizations and health insurers
• Managed care affiliated care team members involved with patient evaluation, education, and follow-up for adult patients with MDD including: physicians, pharmacists, registered nurses, and care managers

Purpose Statement

Adult MDD is a serious medical illness affecting 15 million American adults, or approximately 5-8% of the adult population in a given year. Unlike normal emotional experiences of sadness, loss, or passing mood states, MDD is persistent and can significantly interfere with an individual’s thoughts, behavior, mood, activity, and physical health. Over 50% of patients with adult MDD develop role impairment. There is no single cause of MDD—psychological, biological, and environmental factors may all contribute to its development.

Adult MDD has also been associated with significant medical comorbidity. In addition, adult MDD affects patients' marital, parental, social, and vocational functioning. The disorder is unremitting in about 15% of patients and recurrent in another 35%. Compounding the problem is that treatment is often delayed. These factors highlight the need for changes in the delivery of mental health services to enhance timeliness and quality of care in adult MDD.

The economic toll associated with the treatment of depression is enormous—in 2000, the U.S. economic burden of depressive disorders was estimated to be $83.1 billion. More than 30% of these costs are attributable to direct medical expenses.

Educational Objectives (Track 1)
After completing this activity, the participant should be better able to:

• Implement evidence-based sequenced management strategies based on the 2010 APA Practice Guideline to enhance clinical decision-making for adult patients with MDD
• Assess the clinical and economic value of atypical antipsychotics for the treatment of adult patients with MDD who do not achieve full remission
• Explain how the 2010 APA Practice Guideline can integrate with a managed care algorithm for optimal value of therapeutic options
• Provide appropriate care and counsel for patients and their families
• Provide accurate and appropriate counsel as part of the treatment team

Educational Objectives (Track 2)
After completing this activity, the participant should be better able to:

• Apply the use of decision support tools, such as comparative effectiveness research (CER) and pharmacoeconomic (PE) models, that enable evidence-based treatment decisions for adult patients with MDD
• Implement a system-wide approach to collaborative care, stepped care, and medication therapy management
• Implement patient screening and monitoring that leverages health information technology advances to improve outcomes for adult patients with MDD
• Provide appropriate care and counsel for patients and their families
• Provide accurate and appropriate counsel as part of the treatment team

Distinguished Faculty (Track 1)

George I. Papakostas, MD Director, Treatment-resistant Depression Studies Department of Psychiatry Massachusetts General Hospital Associate Professor of Psychiatry Harvard Medical School Click here for biography

Charles L. Raison, MD Associate Professor Department of Psychiatry University of Arizona School of Medicine Norton School of Family and Consumer Sciences University of Arizona Click here for biography

Distinguished Faculty (Track 2)

Carl V. Asche, PhD, MBA Professor, Director, Center for Health Outcomes Research University of Illinois College of Medicine Click here for biography

David K. Nace, MD Vice President, Medical Director McKesson Corporation / RelayHealth Co-chair, Center for eHealth Patient Centered Primary Care Collaborative Click here for biography

Activity Agenda (Track 1)

Evidence-based Sequenced Treatment Management From the 2010 APA Practice Guideline
George I. Papakostas, MD

Atypical Antipsychotics to Achieve Remission With Adult MDD: a Clinical and Economic Assessment
Charles L. Raison, MD

Activity Agenda (Track 2)

Decision Support Tools for Adult MDD: Applying CER and PE Models for Optimal Outcomes
Carl V. Asche, PhD, MBA

Implementing a System-wide Care Approach to Improve Outcomes for Adult Patients With MDD
David K. Nace, MD

Physician Continuing Medical Education

Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Postgraduate Institute for Medicine and Impact Education, LLC. Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement (Per Track)
The Postgraduate Institute for Medicine designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Pharmacist Continuing Education

Accreditation Statement

	Postgraduate Institute for Medicine is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Credit Designation (Per Track)
Postgraduate Institute for Medicine designates this continuing education activity for 1.0 contact hours (0.10 CEUs) of the Accreditation Council for Pharmacy Education.

• Track 1 Universal Activity Number: 0809-9999-11-142-H01-P
• If you have received credit for UPN 0809-9999-11-099-L01-P, you are not eligible for this activity
• Track 2 Universal Activity Number: 0809-9999-11-143-H01-P
• If you have received credit for UPN 0809-9999-11-100-L01-P, you are not eligible for this activity

Type of Activity
Knowledge-based

Nursing Continuing Education

Credit Designation (Per Track)
This educational activity for 1.0 contact hours is provided by Postgraduate Institute for Medicine.

Accreditation Statement

	Postgraduate Institute for Medicine is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

A statement of credit will be issued only upon receipt of a completed activity evaluation form.

Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) assesses conflict of interest with its instructors, planners, managers, and other individuals who are in a position to control the content of CME activities. All relevant conflicts of interest that are identified are thoroughly vetted by PIM for fair balance, scientific objectivity of studies utilized in this activity, and patient care recommendations. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Method of Participation and Request for Credit
There are no fees for participating in and receiving CME/CE credit for this activity. During the period December 15, 2011, through June 15, 2013, participants must 1) read the learning objectives and faculty disclosures; 2) study the educational activity; 3) successfully complete the online post-test, with a passing score of 70% or better; 4) complete the online evaluation form. Upon successful completion of post-test and evaluation, you will have access to an immediate online certificate.

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. Postgraduate Institute for Medicine (PIM), Impact Education, LLC, and Bristol-Myers Squibb do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of PIM, Impact Education, LLC, or Bristol-Myers Squibb. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Media
Internet

Fee Information
There is no fee for this educational activity.