Collaborative care model to improve outcomes in major depression.
OBJECTIVE
To develop a pharmacist intervention to improve depression care and outcomes within a primary care setting.


METHODS
Pragmatic, randomized trial of a clinical pharmacist collaborative care intervention versus usual care in a busy, academic family practice clinic.


RESULTS
Seventy-four patients diagnosed with a new episode of major depression and started on antidepressant medications were randomized to enhanced care (EC) or usual care (UC) groups. EC consists of a clinical pharmacist collaborating with primary care providers (PCPs) to facilitate education, initiation, and titration of acute-phase antidepressant treatment to monitor treatment adherence and to prevent relapse. Control patients receive UC by their PCP. The main end point is reduction of depression symptoms over time as measured by the Hopkins Symptom Checklist (SCL-20). Other outcomes include the Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV) criteria for major depression, health-related quality of life measured by the Medical Outcomes Study Short Form 12 (SF-12), medication adherence, patient satisfaction, and healthcare utilization. The main end point and the cost of treating major depression will be used to estimate the cost-effectiveness of the collaborative care model.


CONCLUSIONS
The study is a unique, ongoing trial that may have important implications for the treatment of depression in primary care settings as well as new roles for clinical pharmacists.
Boudreau
Denise M
DM
Department of Pharmacy, University of Washington, Seattle, WA 98195-7630, USA. dboudreau@u.washington.edu
Capoccia
Kam L
KL
Sullivan
Sean D
SD
Blough
David K
DK
Ellsworth
Allan J
AJ
Clark
Dave L
DL
Katon
Wayne J
WJ
Walker
Edward A
EA
Stevens
Nancy G
NG
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D003863:Depression / Q000628:therapy*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D017146:Models, Organizational; D010595:Pharmacists / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D016896:Treatment Outcome
D000928:Antidepressive Agents