title: Re-engineering systems for the treatment of depression in primary care: cluster randomised controlled trial.
abstract: 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.
authors.affiliation: Dartmouth Medical School, HB 7250, Hanover, NH 03755, USA. allen.j.dietrich@dartmouth.edu
authors.forename: Allen J
authors.initials: AJ
authors.lastname: Dietrich
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Oxman
authors.forename: John W
authors.initials: JW
authors.lastname: Williams
authors.forename: Herbert C
authors.initials: HC
authors.lastname: Schulberg
authors.forename: Martha L
authors.initials: ML
authors.lastname: Bruce
authors.forename: Pamela W
authors.initials: PW
authors.lastname: Lee
authors.forename: Sheila
authors.initials: S
authors.lastname: Barry
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Raue
authors.forename: Jean J
authors.initials: JJ
authors.lastname: Lefever
authors.forename: Moonseong
authors.initials: M
authors.lastname: Heo
authors.forename: Kathryn
authors.initials: K
authors.lastname: Rost
authors.forename: Kurt
authors.initials: K
authors.lastname: Kroenke
authors.forename: Martha
authors.initials: M
authors.lastname: Gerrity
authors.forename: Paul A
authors.initials: PA
authors.lastname: Nutting
mesh_terms: 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