Long-term effectiveness of disseminating quality improvement for depression in primary care.
BACKGROUND
This article addresses whether dissemination of short-term quality improvement (QI) interventions for depression to primary care practices improves patients' clinical outcomes and health-related quality of life (HRQOL) over 2 years, relative to usual care (UC).


METHODS
The sample included 1299 patients with current depressive symptoms and 12-month, lifetime, or no depressive disorder from 46 primary care practices in 6 managed care organizations. Clinics were randomized to UC or 1 of 2 QI programs that included training local experts and nurse specialists to provide clinician and patient education, assessment, and treatment planning, plus either nurse care managers for medication follow-up (QI-meds) or access to trained psychotherapists (QI-therapy). Outcomes were assessed every 6 months for 2 years.


RESULTS
For most outcomes, differences between intervention and UC patients were not sustained for the full 2 years. However, QI-therapy reduced overall poor outcomes compared with UC by about 8 percentage points throughout 2 years, and by 10 percentage points compared with QI-meds at 24 months. Both interventions improved patients' clinical and role outcomes, relative to UC, over 12 months (eg, a 10-11 and 6-7 percentage point difference in probable depression at 6 and 12 months, respectively).


CONCLUSIONS
While most outcome improvements were not sustained over the full 2 study years, findings suggest that flexible dissemination of short-term, QI programs in managed primary care can improve patient outcomes well after program termination. Models that support integrated psychotherapy and medication-based treatment strategies in primary care have the potential for relatively long-term patient benefits.
Sherbourne
C D
CD
Health Program, RAND, 1700 Main St, Santa Monica, CA 90407-2138, USA. Cathy_Sherbourne@rand.org
Wells
K B
KB
Duan
N
N
Miranda
J
J
Unützer
J
J
Jaycox
L
L
Schoenbaum
M
M
Meredith
L S
LS
Rubenstein
L V
LV
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010347:Patient Care Planning; D010348:Patient Care Team; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration*; D011613:Psychotherapy / Q000379:methods; D011788:Quality of Life
D000928:Antidepressive Agents