title: Primary care patients' involvement in decision-making is associated with improvement in depression.
abstract: 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.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Clever
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Ford
authors.forename: Lisa V
authors.initials: LV
authors.lastname: Rubenstein
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Rost
authors.forename: Lisa S
authors.initials: LS
authors.lastname: Meredith
authors.forename: Cathy D
authors.initials: CD
authors.lastname: Sherbourne
authors.forename: Nae-Yuh
authors.initials: NY
authors.lastname: Wang
authors.forename: Jose J
authors.initials: JJ
authors.lastname: Arbelaez
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Cooper
mesh_terms: 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