BMJ, doi: 10.1136/bmj.38219.481250.55, (Published 2 September 2004)

PRIMARY CARE

Re-engineering systems for the treatment of depression in primary care: cluster randomised controlled trial

Allen J Dietrich 1, Thomas E Oxman 1, John W Williams Jr2, Herbert C Schulberg 3, Martha L Bruce 3, Pamela W Lee 3, Sheila Barry 1, Patrick J Raue 3, Jean J Lefever 3, Moonseong Heo 3, Kathryn Rost 4, Kurt Kroenke 5, Martha Gerrity 6, Paul A Nutting 7

1 Dartmouth Medical School, HB 7250, Hanover, NH 03755, USA
2 Center for Health Services Research. Durham Veterans Affairs Medical Center, Durham, NC 27705, USA
3 Weill Medical College of Cornell University, White Plains, NY 10605, USA
4 University of Colorado Health Sciences Center, UCHSC at Fitzsimmons, Aurora, CO 80010, USA
5 Regenstrief Institute, Indianapolis, IN 46202-2859, USA
6 Portland Veterans Administration Medical Center, Portland, OR 97207-1034, USA
7 Center for Research Strategies, Denver, CO 80203-1694, USA

Objective To test the effectiveness of an evidence based model for management of depression in primary care with support from quality improvement resources.

Design Cluster randomised controlled trial.

Setting Five healthcare organisations in the United States and 60 affiliated practices.

Patients 405 patients, aged ≥18 years, starting or changing treatment for depression.

Intervention Care provided by clinicians, with staff providing telephone support under supervision from a psychiatrist.

Main outcome measures Severity of depression at three and six months (Hopkins symptom checklist-20): response to treatment (≥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).

Conclusion 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.

(Accepted 19 July 2004)
Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?

Relevant Articles

Collaborative care for depression
Gregory Simon
BMJ 2006 332: 249-250. [Extract] [Full Text] [PDF]

Evidence based model improves care of depression
BMJ 2004 329: 0. [Full Text]

This article has been cited by other articles:

  • Gilbody, S. DPhil, Sheldon, T. DSc, House, A. DM (2008). Screening and case-finding instruments for depression: a meta-analysis. CMAJ 178: 997-1003 [Abstract] [Full text]  
  • Paradiso, S., Vaidya, J., Tranel, D., Kosier, T., Robinson, R. G. (2008). Nondysphoric Depression Following Stroke. J. Neuropsychiatry Clin. Neurosi. 20: 52-61 [Abstract] [Full text]  
  • Nutting, P. A., Gallagher, K., Riley, K., White, S., Dickinson, W. P., Korsen, N., Dietrich, A. (2008). Care Management for Depression in Primary Care Practice: Findings From the RESPECT-Depression Trial. Ann Fam Med 6: 30-37 [Abstract] [Full text]  
  • Lee, P. W., Dietrich, A. J., Oxman, T. E., Williams, J. W. Jr, Barry, S. L. (2007). Sustainable Impact of a Primary Care Depression Intervention. J Am Board Fam Med 20: 427-433 [Abstract] [Full text]  
  • Rubenstein, L. V., Rayburn, N. R., Keeler, E. B., Ford, D. E., Rost, K. M., Sherbourne, C. D. (2007). Predicting Outcomes of Primary Care Patients With Major Depression: Development of a Depression Prognosis Index. Psychiatr. Serv. 58: 1049-1056 [Abstract] [Full text]  
  • Brignell, M., Wootton, R., Gray, L. (2007). The application of telemedicine to geriatric medicine. Age Ageing 36: 369-374 [Abstract] [Full text]  
  • Oeffinger, K. C., McCabe, M. S. (2006). Models for Delivering Survivorship Care. JCO 24: 5117-5124 [Abstract] [Full text]  
  • Rubenstein, L. V. (2006). Improving care for depression: there's no free lunch.. ANN INTERN MED 145: 544-546 [Full text]  
  • Simon, G. E., Ludman, E. J., Operskalski, B. H. (2006). Randomized Trial of a Telephone Care Management Program for Outpatients Starting Antidepressant Treatment. Psychiatr. Serv. 57: 1441-1445 [Abstract] [Full text]  
  • Brown, J., Gilmour, W. H., Macdonald, E. B. (2006). Return to work after ill-health retirement in Scottish NHS staff and teachers. Occup Med (Lond) 56: 480-484 [Abstract] [Full text]  
  • Patel, K. K., Butler, B., Wells, K. B. (2006). What is necessary to transform the quality of mental health care.. Health Aff (Millwood) 25: 681-693 [Abstract] [Full text]  
  • Lyness, J. M., Heo, M., Datto, C. J., Ten Have, T. R., Katz, I. R., Drayer, R., Reynolds, C. F. III, Alexopoulos, G. S., Bruce, M. L. (2006). Outcomes of Minor and Subsyndromal Depression among Elderly Patients in Primary Care Settings. ANN INTERN MED 144: 496-504 [Abstract] [Full text]  
  • Reynolds, C. F. III, Dew, M. A., Pollock, B. G., Mulsant, B. H., Frank, E., Miller, M. D., Houck, P. R., Mazumdar, S., Butters, M. A., Stack, J. A., Schlernitzauer, M. A., Whyte, E. M., Gildengers, A., Karp, J., Lenze, E., Szanto, K., Bensasi, S., Kupfer, D. J. (2006). Maintenance treatment of major depression in old age.. NEJM 354: 1130-1138 [Abstract] [Full text]  
  • Simon, G. (2006). Collaborative care for depression. BMJ 332: 249-250 [Full text]  
  • Thomas, M. R., Waxmonsky, J. A., Gabow, P. A., Flanders-McGinnis, G., Socherman, R., Rost, K. (2005). Prevalence of Psychiatric Disorders and Costs of Care Among Adult Enrollees in a Medicaid HMO. Psychiatr. Serv. 56: 1394-1401 [Abstract] [Full text]  
  • Solberg, L. I., Trangle, M. A., Wineman, A. P. (2005). Follow-Up and Follow-Through of Depressed Patients in Primary Care: The Critical Missing Components of Quality Care. J Am Board Fam Med 18: 520-527 [Abstract] [Full text]  
  • Schulberg, H. C., Lee, P. W., Bruce, M. L., Raue, P. J., Lefever, J. J., Williams, J. W. Jr, Dietrich, A. J., Nutting, P. A. (2005). Suicidal Ideation and Risk Levels Among Primary Care Patients With Uncomplicated Depression. Ann Fam Med 3: 523-528 [Abstract] [Full text]  
  • Lindbloom, E. J. (2005). DIETRICH RECEIVES CURTIS G. HAMES RESEARCH AWARD, CALL FOR NEW MODEL PAPERS. Ann Fam Med 3: 373-375 [Full text]  
  • Wettstein, R. M. (2005). Quality and Quality Improvement in Forensic Mental Health Evaluations. J Am Acad Psychiatry Law 33: 158-175 [Abstract] [Full text]  
  • Lehman, R. (2005). Evidently.... Evid. Based Med. 10: 8-8 [Full text]  
  • (2005). Other articles noted. Evid. Based Med. 10: 31-32 [Full text]  
  • Pincus, H. A., Houtsinger, J. K., Bachman, J., Keyser, D. (2005). Depression In Primary Care: Bringing Behavioral Health Care Into The Mainstream. Health Aff (Millwood) 24: 271-276 [Abstract] [Full text]  
  • (2004). Evidence-Based Approach to Treating Depression in Primary Care. JWatch Psychiatry 2004: 9-9 [Full text]  
  • (2004). Evidence-Based Approach to Treating Depression in Primary Care. JWatch Gastroenterology 2004: 9-9 [Full text]  
  • (2004). Evidence-Based Approach to Treating Depression in Primary Care. JWatch General 2004: 5-5 [Full text]  
  • Von Korff, M. (2004). Can care management enhance integration of primary and specialty care?. BMJ 329: 605-605 [Full text]  

Rapid Responses:

Read all Rapid Responses

Re-engineering systems for the treatment of depression in primary care: cluster randomized controlled trial: Other confounding factors may account for results
Samuel Y Wong
bmj.com, 10 Sep 2004 [Full text]
Telephone consultations can be rewarding for the doctor.
Richard l Davies
bmj.com, 12 Sep 2004 [Full text]
Depression in primary care: telephone consultation as an augmentation strategy.
Dr. Naseem A. Qureshi MD, IMAPA, LMIPS, et al.
bmj.com, 19 Sep 2004 [Full text]
Re: Re-engineering systems for the treatment of depression in primary care: cluster randomized controlled trial: Other confounding factors may account for results
Allen J. Dietrich, et al.
bmj.com, 20 Sep 2004 [Full text]
Re-engineering systems for the treatment of depression in primary care: the appropriateness of the treatment applied
Sepideh Omidvari
bmj.com, 4 Oct 2004 [Full text]

Student BMJ

Asylum seekers' care

UK medical students have published unreleased government plans to restrict failed asylum seekers' access to medical care

www.student.bmj.com

Listen to the latest BMJ Interview