Managing depression as a chronic disease: a randomised trial of ongoing treatment in primary care.
OBJECTIVE
To evaluate the long term effect of ongoing intervention to improve treatment of depression in primary care.


METHODS
Randomised controlled trial.


METHODS
Twelve primary care practices across the United States.


METHODS
211 adults beginning a new treatment episode for major depression; 94% of patients assigned to ongoing intervention participated.


METHODS
Practices assigned to ongoing intervention encouraged participating patients to engage in active treatment, using practice nurses to provide care management over 24 months.


METHODS
Patients' report of remission and functioning.


RESULTS
Ongoing intervention significantly improved both symptoms and functioning at 24 months, increasing remission by 33 percentage points (95% confidence interval 7% to 46%), improving emotional functioning by 24 points (11 to 38) and physical functioning by 17 points (6 to 28). By 24 months, 74% of patients in enhanced care reported remission, with emotional functioning exceeding 90% of population norms and physical functioning approaching 75% of population norms.


CONCLUSIONS
Ongoing intervention increased remission rates and improved indicators of emotional and physical functioning. Studies are needed to compare the cost effectiveness of ongoing depression management with other chronic disease treatment routinely undertaken by primary care.
Rost
Kathryn
K
Center for Studies in Family Medicine, Department of Family Medicine, University of Colorado Health Sciences Center, UCHSC at Fitzsimons, Aurora, CO 80045-0508, USA. Kathryn.Rost@UCHSC.edu
Nutting
Paul
P
Smith
Jeffrey L
JL
Elliott
Carl E
CE
Dickinson
Miriam
M
D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D002908:Chronic Disease; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D004644:Emotions; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods; D011613:Psychotherapy / Q000379:methods; D016896:Treatment Outcome; D014481:United States
D000928:Antidepressive Agents