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.
journal_name
BMJjournal_title
BMJ (Clinical research ed.)authors
Dietrich AJ,Oxman TE,Williams JW Jr,Schulberg HC,Bruce ML,Lee PW,Barry S,Raue PJ,Lefever JJ,Heo M,Rost K,Kroenke K,Gerrity M,Nutting PAdoi
10.1136/bmj.38219.481250.55keywords:
subject
Has Abstractpub_date
2004-09-11 00:00:00pages
602issue
7466eissn
0959-8138issn
1756-1833pii
bmj.38219.481250.55journal_volume
329pub_type
临床试验,杂志文章,多中心研究,随机对照试验abstract::Managed care has entered the lexicon of healthcare reform, but confusion and ignorance surround its meaning and purpose. It seeks to cut the costs of health care while maintaining its quality, but the evidence that it is able to achieve these aims is mixed. As well as raising awareness and understanding of the issues ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.314.7097.1823
更新日期:1997-06-21 00:00:00
abstract:OBJECTIVE:To estimate the comparative clinical efficacy and acceptability of non-surgical brain stimulation for the acute treatment of major depressive episodes in adults. DESIGN:Systematic review with pairwise and network meta-analysis. DATA SOURCES:Electronic search of Embase, PubMed/Medline, and PsycINFO up to 8 M...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
doi:10.1136/bmj.l1079
更新日期:2019-03-27 00:00:00
abstract:OBJECTIVES:To investigate the effect of Chlamydia pneumoniae infection on future development of ischaemic heart disease and mortality. DESIGN:Prospective longitudinal study. SETTING:Caerphilly, South Wales. SUBJECTS:Plasma specimens were collected during 1979-83 from 1773 men aged 45-59 years. These were tested for ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.318.7190.1035
更新日期:1999-04-17 00:00:00
abstract:OBJECTIVES:To assess and improve the quality of care provided to women undergoing induced abortion. DESIGN:Two rounds of prospective, criterion based case note review audit. SETTING:Ten NHS gynaecology units throughout Scotland. SUBJECTS:2004 patient episodes of abortion care identified consecutively during two roun...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.309.6946.15
更新日期:1994-07-02 00:00:00
abstract:OBJECTIVES:To compare "hospital at home" and hospital care as an inpatient in acute exacerbations of chronic obstructive pulmonary disease. DESIGN:Prospective randomised controlled trial with three months' follow up. SETTING:University teaching hospital offering secondary care service to 350 000 patients. PATIENTS:S...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.321.7271.1265
更新日期:2000-11-18 00:00:00
abstract:OBJECTIVE:To assess whether customised mobile phone reminders would improve adherence to therapy and thus decrease virological failure among HIV infected patients starting antiretroviral treatment (ART). DESIGN:Randomised controlled trial among HIV infected patients initiating antiretroviral treatment. SETTING:Three ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1136/bmj.g5978
更新日期:2014-10-24 00:00:00
abstract:OBJECTIVE:To investigate the psychosocial factors associated with consultation for low back pain. DESIGN:Two phase cross sectional postal survey. SETTING:Bradford Metropolitan Health District. SUBJECTS:1813 adults responding to the phase 1 questionnaire. 540 of the 782 with an episode of low back pain in the past 12...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.317.7172.1564
更新日期:1998-12-05 00:00:00
abstract::An increase in the incidence of cardiovascular disease has generally been observed in postmenopausal women, but there have been few studies of the association between menopausal state and atherosclerosis. In this study 294 premenopausal and 319 postmenopausal women aged 45 to 55 were examined radiographically for calc...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.298.6674.642
更新日期:1989-03-11 00:00:00
abstract:OBJECTIVE:Firstly, to assess the completeness of ascertainment in the National Congenital Anomaly System (NCAS), the basis for congenital anomaly surveillance in England and Wales, and its variation by defect, geographical area, and socioeconomic deprivation. Secondly, to assess the impact of the lack of data on pregna...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.38300.665301.3A
更新日期:2005-01-01 00:00:00
abstract:OBJECTIVES:To examine the risk of atrial fibrillation in relation to the whole spectrum of thyroid function in a large cohort of patients. DESIGN:Population based cohort study of general practice patients identified by linkage of nationwide registries at the individual level. SETTING:Primary care patients in the city...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.e7895
更新日期:2012-11-27 00:00:00
abstract:OBJECTIVE:To assess the validity, reliability, and acceptability of the short form 36 (SF 36) health survey questionnaire (a shortened version of a battery of 149 health status questions) as a measure of patient outcome in a broad sample of patients suffering from four common clinical conditions. DESIGN:Postal questio...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.306.6890.1440
更新日期:1993-05-29 00:00:00
abstract:OBJECTIVE:To evaluate the relative efficacy of the World Health Organization 2005 campaign (WHO-5) and other interventions to promote hand hygiene among healthcare workers in hospital settings and to summarize associated information on use of resources. DESIGN:Systematic review and network meta-analysis. DATA SOURCES...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.h3728
更新日期:2015-07-28 00:00:00
abstract:OBJECTIVES:To describe the menstrual experience of women referred for menstrual problems, in particular menorrhagia (excessive menstrual loss), and to assess associations with reasons for referral given by their general practitioners, the women's understanding of the reasons for their attendance at the hospital clinics...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,多中心研究
doi:10.1136/bmj.323.7303.24
更新日期:2001-07-07 00:00:00
abstract:OBJECTIVE:To evaluate the effect of support with human chorionic gonadotrophin in the luteal phase in women taking part in an in vitro fertilisation programme after buserelin and human menopausal gonadotrophin were used to hyperstimulate their ovaries. DESIGN:Controlled group comparison. SETTING:Outpatient department...
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章
doi:10.1136/bmj.298.6686.1483
更新日期:1989-06-03 00:00:00
abstract:OBJECTIVE:To examine changes in primary care in London in the 11 years since the Acheson report on primary health care in inner London. DESIGN:Analysis of key data from the family health services authority performance indicators and from the Department of Health; study of trends since the time of the Acheson report; e...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.305.6862.1130
更新日期:1992-11-07 00:00:00
abstract:OBJECTIVE:To investigate explanations for social inequalities in health with respect to health related social mobility and cumulative socioeconomic circumstances over the first three decades of life. DESIGN:Longitudinal follow up. SETTING:Great Britain. SUBJECTS:Data from the 1958 birth cohort study (all children bo...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.313.7055.449
更新日期:1996-08-24 00:00:00
abstract::There is currently much debate about how to improve undergraduate medical education, and in particular on how best to prepare students for clinical responsibility. For 20 years a period of trainee internship has formed part of New Zealand medical students' undergraduate training, and the model could have much to offer...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.308.6925.398
更新日期:1994-02-05 00:00:00
abstract:OBJECTIVE:To determine whether being overweight in childhood increases adult obesity and risk of disease. DESIGN:Prospective cohort study. SETTING:City of Newcastle upon Tyne. PARTICIPANTS:932 members of thousand families 1947 birth cohort, of whom 412 attended for clinical examination age 50. MAIN OUTCOME MEASURES...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.323.7324.1280
更新日期:2001-12-01 00:00:00
abstract:OBJECTIVE:To assess the effect of disclosing authors' conflict of interest declarations to peer reviewers at a medical journal. DESIGN:Randomized controlled trial. SETTING:Manuscript review process at the Annals of Emergency Medicine. PARTICIPANTS: Reviewers (n=838) who reviewed manuscripts submitted between 2 June 2...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.l5896
更新日期:2019-11-06 00:00:00
abstract::A brief note on the status of the AIDS pandemic, from the Amsterdam VIIIth International Conference on AIDS, warns that the course of the epidemic is not being altered by prevention efforts. AIDS occurs in every country, usually spread by heterosexual contact, so that women are equally affected with men. WHO estimat...
journal_title:BMJ (Clinical research ed.)
pub_type: 新闻
doi:10.1136/bmj.305.6847.209
更新日期:1992-07-25 00:00:00
abstract:OBJECTIVE:To assess the feasibility and acceptability of screening young children for iron deficiency in a deprived inner city practice and to assess the effects of a programme of dietary education. DESIGN:Prospective study of children in general practice, comparison with historical controls. SETTING:A deprived inner...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.299.6703.838
更新日期:1989-09-30 00:00:00
abstract:OBJECTIVE:To systematically evaluate the published evidence regarding the characteristics and effectiveness of disease management programmes. DESIGN:Meta-analysis. DATA SOURCES:Computerised databases for English language articles during 1987-2001. STUDY SELECTION:102 articles evaluating 118 disease management progra...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析,评审
doi:10.1136/bmj.325.7370.925
更新日期:2002-10-26 00:00:00
abstract:OBJECTIVE:To explore genetic and environmental contributions to the influence of parental social class and region of upbringing on adult human fatness. DESIGN:Survey of sample of adults who had been adopted in childhood to relate their body mass index to sociodemographic variables in a series of multiple linear regres...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.300.6740.1615
更新日期:1990-06-23 00:00:00
abstract:OBJECTIVES:To measure, in a service setting, the effect of magnetic resonance imaging on diagnosis, diagnostic certainty, and patient management in the neurosciences; to measure the cost per patient scanned; to estimate the marginal cost of imaging and compare this with its diagnostic impact; to measure changes in pati...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.303.6815.1435
更新日期:1991-12-07 00:00:00
abstract:OBJECTIVE:To assess the association between genotype at the insertion or deletion polymorphism of the angiotensin converting enzyme gene and risk of coronary restenosis after percutaneous coronary intervention. DESIGN:Meta-analysis of studies before July 2001 that reported on these genotypes and risk of coronary reste...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,meta分析
doi:10.1136/bmj.325.7363.517
更新日期:2002-09-07 00:00:00
abstract:OBJECTIVE:To evaluate the effectiveness of neuromuscular training in reducing the rate of acute knee injury in adolescent female football players. DESIGN:Stratified cluster randomised controlled trial with clubs as the unit of randomisation. SETTING:230 Swedish football clubs (121 in the intervention group, 109 in th...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmj.e3042
更新日期:2012-05-03 00:00:00
abstract:OBJECTIVE:To assess the effectiveness of a teacher led intervention to improve teenagers' knowledge about emergency contraception. DESIGN:Cluster randomised controlled trial. SETTING:24 mixed sex, state secondary schools in Avon, south west England. PARTICIPANTS:1974 boys and 1820 girls in year 10 (14-15 year olds)....
journal_title:BMJ (Clinical research ed.)
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1136/bmj.324.7347.1179
更新日期:2002-05-18 00:00:00
abstract:OBJECTIVE:To estimate the association between maternal age and fetal death (spontaneous abortion, ectopic pregnancy, stillbirth), taking into account a woman's reproductive history. DESIGN:Prospective register linkage study. SUBJECTS:All women with a reproductive outcome (live birth, stillbirth, spontaneous abortion ...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章
doi:10.1136/bmj.320.7251.1708
更新日期:2000-06-24 00:00:00
abstract::Since the World Health Organization (WHO) set a goal in 1988 of eradicating polio worldwide by 2000, the incidence of the disease has declined by 90% around the world, with national immunization days conducted in more than 120 countries. More than 450 million children were immunized in 1998 alone. Now, with only abo...
journal_title:BMJ (Clinical research ed.)
pub_type: 新闻
doi:10.1136/bmj.318.7186.756
更新日期:1999-03-20 00:00:00
abstract::The studies reviewed here show that the duration and severity of individual episodes of back pain can be lessened, reducing recurrences and their cost in terms of suffering and lost work. Frank examines differential diagnosis; acute, chronic, and intractable pain; and service implications. Modern management emphasises...
journal_title:BMJ (Clinical research ed.)
pub_type: 杂志文章,评审
doi:10.1136/bmj.306.6882.901
更新日期:1993-04-03 00:00:00