Re-engineering Systems for the Treatment of Depression in Primary Care: Cluster Randomised Controlled Trial

Overview

Journal BMJ

Specialty General Medicine

Date 2004 Sep 4

PMID 15345600

Citations 100

Authors

Allen J Dietrich

Thomas E Oxman

John W Williams Jr

Herbert C Schulberg

Martha L Bruce

Pamela W Lee

Sheila Barry

Patrick J Raue

Jean J Lefever

Moonseong Heo

Kathryn Rost

Kurt Kroenke

Martha Gerrity

Paul A Nutting

Affiliations

Soon will be listed here.

Abstract

Objective: To test the effectiveness of an evidence based model for management of depression in primary care with support from quality improvement resources.

Design: Cluster randomised controlled trial.

Setting: Five healthcare organisations in the United States and 60 affiliated practices.

Patients: 405 patients, aged > or = 18 years, starting or changing treatment for depression.

Intervention: Care provided by clinicians, with staff providing telephone support under supervision from a psychiatrist.

Main Outcome Measures: Severity of depression at three and six months (Hopkins symptom checklist-20): response to treatment (> or = 50% decrease in scores) and remission (score of < 0.5).

Results: At six months, 60% (106 of 177) of patients in intervention practices had responded to treatment compared with 47% (68 of 146) of patients in usual care practices (P = 0.02). At six months, 37% of intervention patients showed remission compared with 27% for usual care patients (P = 0.014). 90% of intervention patients rated their depression care as good or excellent at six months compared with 75% of usual care patients (P = 0.0003).

Conclusion: Resources such as quality improvement programmes can be used effectively in primary care to implement evidence based management of depression and improve outcomes for patients with depression.

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