Clinical Outcomes in Measurement-based Treatment (Comet): a trial of depression monitoring and feedback to primary care physicians.
BACKGROUND
Despite the availability of effective treatments for depression, many patients under the care of primary care physicians do not achieve remission. Clinical Outcomes in Measurement-based Treatment (COMET) was designed to assess whether communicating patient-reported depression symptom severity to primary care physicians affects patient outcomes at 6 months.


METHODS
Nine hundred fifteen patients (intervention: n = 503; control: n = 412) diagnosed with major depressive disorder were enrolled in a prospective trial in which physician practice sites were assigned to either the intervention or control study arm. Only patients who were prescribed an antidepressant by their physician were eligible, but medication type was independent of the study protocol. Intervention-arm physicians received monthly updates on their patients' depression severity, which was determined with the nine-item Patient Health Questionnaire (PHQ-9) administered during telephone interviews. Remission was defined as a PHQ-9 score <5 at 6 months; response was defined as a score reduction ≥50%.


RESULTS
Among patients with baseline PHQ-9 score ≥5, 45.0% achieved remission (46.7% intervention versus 42.8% control) and 63.9% responded (67.0% intervention versus 59.7% control) at 6 months. After adjusting for baseline demographic and clinical variables, odds of remission (odds ratio [OR], 1.59 [95% CI, 1.07-2.37]) or response (OR, 2.02 [95% CI, 1.36-3.02]) were significantly greater for the intervention group than for control patients.


CONCLUSIONS
This study demonstrated that regular patient symptom monitoring with feedback to physicians improved outcomes of depression treatment in the primary care setting. Determining reasons for the high observed nonremission rates requires further investigation.
Depression Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. ayeung@partners.org
Albert S
AS
Yeung
Yonghua
Y
Jing
Susan K
SK
Brenneman
Trina E
TE
Chang
Lee
L
Baer
Tony
T
Hebden
Iftekhar
I
Kalsekar
Robert D
RD
McQuade
Jonathan
J
Kurlander
Jean
J
Siebenaler
Maurizio
M
Fava
D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000175:diagnosis* / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D007406:Interview, Psychological / Q000379:methods; D007407:Interviews as Topic / Q000379:methods; D008297:Male; D008875:Middle Aged; D058007:Physicians, Primary Care; D011320:Primary Health Care / Q000379:methods*; D011446:Prospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
D000928:Antidepressive Agents