title: Randomized trial of a depression management program in high utilizers of medical care.
abstract: BACKGROUND
  High utilizers of nonpsychiatric health care services have disproportionally high rates of undiagnosed or undertreated depression.
  
  
  OBJECTIVE
  To determine the impact of offering a systematic primary care-based depression treatment program to depressed "high utilizers" not in active treatment.
  
  
  METHODS
  Randomized clinical trial.
  
  
  METHODS
  One hundred sixty-three primary care practices in 3 health maintenance organizations located in different geographic regions of the United States.
  
  
  METHODS
  A group of 1465 health maintenance organization members were identified as depressed high utilizers using a 2-stage telephone screening process. Eligibility criteria were met by 410 patients and 407 agreed to enroll: 218 in the depression management program (DMP) practices and 189 in the usual care (UC) group.
  
  
  METHODS
  The DMP included patient education materials, physician education programs, telephone-based treatment coordination, and antidepressant pharmacotherapy initiated and managed by patients' primary care physicians.
  
  
  METHODS
  Depression severity was measured using the Hamilton Depression Rating Scale (Ham-D) and functional status using the Medical Outcomes Study 20-item short form (SF-20) subscales. Outpatient visit and hospitalization rates were measured using the health plan's encounter data.
  
  
  RESULTS
  Based on an intent-to-treat analysis, at least 3 antidepressant prescriptions were filled in the first 6 months by 151 (69.3%) of 218 of DMP patients vs 35 (18.5%) of 189 in UC (P < .001). Improvements in Ham-D scores were significantly greater in the intervention group at 6 weeks (P = .04), 3 months (P = .02), 6 months (P < .001), and 12 months (P < .001). At 12 months, DMP intervention patients were more improved than UC patients on the mental health, social functioning, and general health perceptions scales of the SF-20 (P < .05 for all).
  
  
  CONCLUSIONS
  In depressed high utilizers not already in active treatment, a systematic primary care-based treatment program can substantially increase adequate antidepressant treatment, decrease depression severity, and improve general health status compared with usual care.
authors.affiliation: Dean Foundation for Health, Research, and Education, Middleton, Wis., USA. katzelnick_david_j@ssmhc.com
authors.forename: D J
authors.initials: DJ
authors.lastname: Katzelnick
authors.forename: G E
authors.initials: GE
authors.lastname: Simon
authors.forename: S D
authors.initials: SD
authors.lastname: Pearson
authors.forename: W G
authors.initials: WG
authors.lastname: Manning
authors.forename: C P
authors.initials: CP
authors.lastname: Helstad
authors.forename: H J
authors.initials: HJ
authors.lastname: Henk
authors.forename: S M
authors.initials: SM
authors.lastname: Cole
authors.forename: E H
authors.initials: EH
authors.lastname: Lin
authors.forename: L H
authors.initials: LH
authors.lastname: Taylor
authors.forename: K A
authors.initials: KA
authors.lastname: Kobak
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D003866:Depressive Disorder / Q000453:epidemiology / Q000517:prevention & control*; D005194:Family Practice; D005260:Female; D006279:Health Maintenance Organizations; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010353:Patient Education as Topic; D011320:Primary Health Care; D011569:Psychiatric Status Rating Scales; D020280:Sertraline / Q000627:therapeutic use
chemical_list: D000928:Antidepressive Agents; D020280:Sertraline