Re-engineering systems for the treatment of depression in primary care: cluster randomised controlled trial.
OBJECTIVE
To test the effectiveness of an evidence based model for management of depression in primary care with support from quality improvement resources.


METHODS
Cluster randomised controlled trial.


METHODS
Five healthcare organisations in the United States and 60 affiliated practices.


METHODS
405 patients, aged > or = 18 years, starting or changing treatment for depression.


METHODS
Care provided by clinicians, with staff providing telephone support under supervision from a psychiatrist.


METHODS
Severity of depression at three and six months (Hopkins symptom checklist-20): response to treatment (> or = 50% decrease in scores) and remission (score of < 0.5).


RESULTS
At six months, 60% (106 of 177) of patients in intervention practices had responded to treatment compared with 47% (68 of 146) of patients in usual care practices (P = 0.02). At six months, 37% of intervention patients showed remission compared with 27% for usual care patients (P = 0.014). 90% of intervention patients rated their depression care as good or excellent at six months compared with 75% of usual care patients (P = 0.0003).


CONCLUSIONS
Resources such as quality improvement programmes can be used effectively in primary care to implement evidence based management of depression and improve outcomes for patients with depression.
Dietrich
Allen J
AJ
Dartmouth Medical School, HB 7250, Hanover, NH 03755, USA. allen.j.dietrich@dartmouth.edu
Oxman
Thomas E
TE
Williams
John W
JW
Schulberg
Herbert C
HC
Bruce
Martha L
ML
Lee
Pamela W
PW
Barry
Sheila
S
Raue
Patrick J
PJ
Lefever
Jean J
JJ
Heo
Moonseong
M
Rost
Kathryn
K
Kroenke
Kurt
K
Gerrity
Martha
M
Nutting
Paul A
PA
D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D003156:Community Mental Health Services / Q000458:organization & administration*; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*; D019114:Remote Consultation; D012944:Social Support; D013689:Telephone; D014481:United States