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Cited by 749Mental Health Treatment and AccessHealth Policy Implementation ScienceAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Educational and Organizational Interventions to Improve the Management of Depression in Primary Care: A Systematic Review

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Gilbody, Simon, Whitty, Paula, Grimshaw, Jeremy, Thomas, Ruth·2003·JAMA
DOI 10.1001/jama.289.23.3145
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Abstract

CONTEXT: Depression is commonly encountered in primary care settings yet is often missed or suboptimally managed. A number of organizational and educational strategies to improve management of depression have been proposed. The clinical effectiveness and cost-effectiveness of these strategies have not yet been subjected to systematic review. OBJECTIVE: To systematically evaluate the effectiveness of organizational and educational interventions to improve the management of depression in primary care settings. DATA SOURCES: We searched electronic medical and psychological databases from inception to March 2003 (MEDLINE, PsycLIT, EMBASE, CINAHL, Cochrane Controlled Trials Register, United Kingdom National Health Service Economic Evaluations Database, Cochrane Depression Anxiety and Neurosis Group register, and Cochrane Effective Professional and Organisational Change Group specialist register); conducted correspondence with authors; and used reference lists. Search terms were related to depression, primary care, and all guidelines and organizational and educational interventions. STUDY SELECTION: We selected 36 studies, including 29 randomized controlled trials and nonrandomized controlled clinical trials, 5 controlled before-and-after studies, and 2 interrupted time-series studies. Outcomes relating to management and outcome of depression were sought. DATA EXTRACTION: Methodological details and outcomes were extracted and checked by 2 reviewers. Summary relative risks were, where possible, calculated from original data and attempts were made to correct for unit of analysis error. DATA SYNTHESIS: A narrative synthesis was conducted. Twenty-one studies with positive results were found. Strategies effective in improving patient outcome generally were those with complex interventions that incorporated clinician education, an enhanced role of the nurse (nurse case management), and a greater degree of integration between primary and secondary care (consultation-liaison). Telephone medication counseling delivered by practice nurses or trained counselors was also effective. Simple guideline implementation and educational strategies were generally ineffective. CONCLUSIONS: There is substantial potential to improve the management of depression in primary care. Commonly used guidelines and educational strategies are likely to be ineffective. The implementation of the findings from this research will require substantial investment in primary care services and a major shift in the organization and provision of care.

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  • There is a growing body of evidence that supporting people to self-manage their health and care can lead to improvements in clinical and humanistic outcomes, reducing the economic impact of chronic disease and contributing to the sustainability of the global healthcare system.

    “There is a growing body of evidence that shows supporting people to self-manage their health and care can lead to improvements in clinical and humanistic outcomes [12–18], reducing the economic impact of chronic disease and a means of contributing to the sustainability of the global healthcare system.”

    From Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice (2019) · cites this paper as [18]

  • Similar trends have been found in existing literature in several contexts that self-management is essential to optimizing clinical and humanistic outcomes for patients with chronic conditions.

    “Similar trends have been found in existing literature in several contexts that self-management is essential to optimizing clinical and humanistic outcomes for patients with chronic conditions [13, 15, 18, 152–155].”

    From Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice (2019) · cites this paper as [18]

  • GP treatment options for depression and anxiety are generally limited to medication and referral to counselling or cognitive behavioural therapy.

    “general practitioners (GP) treatment options are generally limited to medication and referral to counselling or cognitive behavioural therapy (Gilbody et al. , 2003; McPherson and Armstrong, 2012).”

    From Do depressed and anxious men do groups? What works and what are the barriers to help seeking? (2014) · cites this paper as Gilbody et al. , 2003

  • Various interventions, collaborative care, self-management, and social and community initiatives have shown preliminary evidence of effectiveness in trials in improving outcomes for people experiencing depression and anxiety who may not readily access timely or appropriately targeted care.

    “Various interventions [1], collaborative care [2], self-management [3,4], and social and community initiatives [5] have shown preliminary evidence of effectiveness in trials in improving outcomes for people experiencing depression and anxiety who may not readily access timely or appropriately targeted care.”

    From Development and evaluation of culturally sensitive psychosocial interventions for under-served people in primary care (2014) · cites this paper as [2]

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Authors
Gilbody, S., Whitty, P., Grimshaw, J., & Thomas, R.
Affiliations
University of Leeds (GB)
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2003-06-18
Volume
289
Issue
23
Pages
3145
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.289.23.3145
OpenAlex
W2086627928
Cited by
749
References
70
Citations by year
2026: 4 · 2025: 14 · 2024: 13 · 2023: 10 · 2022: 3 · 2021: 19 · 2020: 17 · 2019: 19 · 2018: 19 · 2017: 26 · 2016: 24 · 2015: 26 · 2014: 46 · 2013: 43 · 2012: 35
FWCI
65.91
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • Newcastle University ePrints (Newcastle Univesity)
Topics
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
depression, primary care, organizational interventions, clinician education, nurse case management, psychosomatic medicine, guideline implementation, primary-secondary care integration, cost-effectiveness, depression treatment
MeSH terms
Clinical Trials as Topic, Cost-Benefit Analysis, Depression, Depressive Disorder, Humans, Mental Health Services, Outcome and Process Assessment, Health Care, Patient Education as Topic, Primary Health Care

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