A randomized trial using computerized decision support to improve treatment of major depression in primary care.
OBJECTIVE
To examine whether feedback and treatment advice for depression presented to primary care physicians (PCPs) via an electronic medical record (EMR) system can potentially improve clinical outcomes and care processes for patients with major depression.


METHODS
Randomized controlled trial.


METHODS
Academically affiliated primary care practice in Pittsburgh, PA.


METHODS
Two hundred primary care patients with major depression on the Primary Care Evaluation of Mental Disorders (PRIME-MD) and who met all protocol-eligibility criteria.


METHODS
PCPs were randomly assigned to 1 of 3 levels of exposure to EMR feedback of guideline-based treatment advice for depression: "active care" (AC), "passive care" (PC), or "usual care" (UC).


RESULTS
Patients' 3- and 6-month Hamilton Rating Scale for Depression (HRS-D) score and chart review of PCP reports of depression care in the 6 months following the depression diagnosis. Only 22% of patients recovered from their depressive episode at 6 months (HRS-D </=7). Patients' mean HRS-D score decreased regardless of their PCPs' guideline-exposure condition (20.4 to 14.2 from baseline to 6-month follow-up; P <.001). However, neither continuous (HRS-D </=7: 22% AC, 23% PC, 22% UC; P =.8) nor categorical measures of recovery (P =.2) differed by EMR exposure condition upon follow-up. Care processes for depression were also similar by PCP assignment despite exposure to repeated reminders of the depression diagnosis and treatment advice (e.g., depression mentioned in >/=3 contacts with usual PCP at 6 months: 31% AC, 31% PC, 18% UC; P =.09 and antidepressant medication suggested/prescribed or baseline regimen modified at 6 months: 59% AC, 57% PC, 52% UC; P =.3).


CONCLUSIONS
Screening for major depression, electronically informing PCPs of the diagnosis, and then exposing them to evidence-based treatment recommendations for depression via EMR has little differential impact on patients' 3- or 6-month clinical outcomes or on process measures consistent with high-quality depression care.
Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213-2582, USA. rollmanbl@msx.upmc.edu
Bruce L
BL
Rollman
Barbara H
BH
Hanusa
Henry J
HJ
Lowe
Trae
T
Gilbert
Wishwa N
WN
Kapoor
Herbert C
HC
Schulberg
D000328:Adult; D003195:Computer Communication Networks; D003661:Decision Support Techniques; D003863:Depression / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D016896:Treatment Outcome