Primary care patients' involvement in decision-making is associated with improvement in depression.
BACKGROUND
Depression is undertreated in primary care settings. Little research investigates the impact of patient involvement in decisions on guideline-concordant treatment and depression outcomes.


OBJECTIVE
The objective of this study was to determine whether patient involvement in decision-making is associated with guideline-concordant care and improvement in depression symptoms.


METHODS
Prospective cohort study.


METHODS
Multisite, nationwide randomized clinical trial of quality improvement strategies for depression in primary care.


METHODS
Primary care patients with current symptoms and probable depressive disorder.


METHODS
Patients rated their involvement in decision-making (IDM) about their care on a 5-point scale from poor to excellent 6 months after entry into the study. Depressive symptoms were measured every 6 months for 2 years using a modified version of the Center for Epidemiologic Studies-Depression (CES-D) scale. We examined probabilities (Pr) of receipt of guideline-concordant care and resolution of depression across IDM groups using multivariate logistic regression models controlling for patient and provider factors.


RESULTS
For each 1-point increase in IDM ratings, the probability of patients' report of receiving guideline-concordant care increased 4% to 5% (adjusted Pr 0.31 vs. 0.50 for the lowest and highest IDM ratings, respectively, P < 0.001). Similarly, for each 1-point increase in IDM ratings, the probability of depression resolution increased 2% to 3% (adjusted Pr 0.10 vs. 0.19 for the lowest and highest IDM ratings respectively, P = 0.004).


CONCLUSIONS
Depressed patients with higher ratings of involvement in medical decisions have a higher probability of receiving guideline-concordant care and improving their symptoms over an 18-month period. Interventions to increase patient involvement in decision-making may be an important means of improving care for and outcomes of depression.
Clever
Sarah L
SL
Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Ford
Daniel E
DE
Rubenstein
Lisa V
LV
Rost
Kathryn M
KM
Meredith
Lisa S
LS
Sherbourne
Cathy D
CD
Wang
Nae-Yuh
NY
Arbelaez
Jose J
JJ
Cooper
Lisa A
LA
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003657:Decision Making; D003863:Depression / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010358:Patient Participation / Q000379:methods* / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D011446:Prospective Studies; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014481:United States