title: Managing depression as a chronic disease: a randomised trial of ongoing treatment in primary care.
abstract: 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.
authors.affiliation: 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
authors.forename: Kathryn
authors.initials: K
authors.lastname: Rost
authors.forename: Paul
authors.initials: P
authors.lastname: Nutting
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Smith
authors.forename: Carl E
authors.initials: CE
authors.lastname: Elliott
authors.forename: Miriam
authors.initials: M
authors.lastname: Dickinson
mesh_terms: 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
chemical_list: D000928:Antidepressive Agents