title: Models in the delivery of depression care: a systematic review of randomised and controlled intervention trials.
abstract: BACKGROUND
  There is still debate as to which features, types or components of primary care interventions are associated with improved depression outcomes. Previous reviews have focused on components of collaborative care models in general practice settings. This paper aims to determine the effective components of depression care in primary care through a systematic examination of both general practice and community based intervention trials.
  
  
  METHODS
  Fifty five randomised and controlled research trials which focused on adults and contained depression outcome measures were identified through PubMed, PsycInfo and the Cochrane Central Register of Controlled Trials databases. Trials were classified according to the components involved in the delivery of treatment, the type of treatment, the primary focus or setting of the study, detailed features of delivery, and the discipline of the professional providing the treatment. The primary outcome measure was significant improvement on the key depression measure.
  
  
  RESULTS
  Components which were found to significantly predict improvement were the revision of professional roles, the provision of a case manager who provided direct feedback and delivered a psychological therapy, and an intervention that incorporated patient preferences into care. Nurse, psychologist and psychiatrist delivered care were effective, but pharmacist delivery was not. Training directed to general practitioners was significantly less successful than interventions that did not have training as the most important intervention. Community interventions were effective.
  
  
  CONCLUSIONS
  Case management is important in the provision of care in general practice. Certain community models of care (education programs) have potential while others are not successful in their current form (pharmacist monitoring).
authors.affiliation: Centre for Mental Health Research, The Australian National University, Canberra, Australia. helen.christensen@anu.edu.au
authors.forename: Helen
authors.initials: H
authors.lastname: Christensen
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Griffiths
authors.forename: Amelia
authors.initials: A
authors.lastname: Gulliver
authors.forename: Dannielle
authors.initials: D
authors.lastname: Clack
authors.forename: Marjan
authors.initials: M
authors.lastname: Kljakovic
authors.forename: Leanne
authors.initials: L
authors.lastname: Wells
mesh_terms: D000328:Adult; D019090:Case Management; D003866:Depressive Disorder / Q000628:therapy*; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic