Re-engineering systems for the treatment of depression in primary care: cluster randomised controlled trial.

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

BMJ

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 PA

doi

10.1136/bmj.38219.481250.55

keywords:

subject

Has Abstract

pub_date

2004-09-11 00:00:00

pages

602

issue

7466

eissn

0959-8138

issn

1756-1833

pii

bmj.38219.481250.55

journal_volume

329

pub_type

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