Cited by 308Health Policy Implementation ScienceMental Health Treatment and AccessPsychotherapy Techniques and Applications

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

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Dietrich, Allen J, Oxman, Thomas E, Williams, John W, Schulberg, Herbert C, Bruce, Martha L, Lee, Pamela W, Barry, Sheila, Raue, Patrick J +6 more·2004·BMJ

Abstract

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 > or = 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 (> or = 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.

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Authors
Dietrich, A. J., Oxman, T. E., Williams, J. W., Schulberg, H. C., Bruce, M. L., Lee, P. W., Barry, S., Raue, P. J., Lefever, J. J., Heo, M., Rost, K., Kroenke, K., Gerrity, M., & Nutting, P. A.
Affiliations
  • Dartmouth College (US)
  • Durham VA Health Care System (US)
  • Cornell University (US)
  • University of Colorado Health (US)
  • Regenstrief Institute (US)
  • Portland VA Medical Center (US)
  • Center for Research Strategies (US)
Corresponding author
Dietrich, Allen J
Venue
BMJ
Publisher
BMJ
Published
2004-09-02
Volume
329
Issue
7466
Pages
602
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
OpenAlex
W2155751713
Cited by
308
References
44
Citations by year
2026: 1 · 2024: 1 · 2023: 3 · 2022: 2 · 2021: 9 · 2020: 10 · 2019: 3 · 2018: 6 · 2017: 4 · 2016: 2 · 2015: 10 · 2014: 28 · 2013: 20 · 2012: 22
FWCI
58.93
Type
journal article
Language
en
Open access
Locations
  • BMJ (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
depression, primary care, telephone support, quality improvement, evidence-based care, depression treatment response, remission, implementation of care models, patient satisfaction
MeSH terms
Adult, Aged, Community Mental Health Services, Depressive Disorder, Female, Humans, Male, Middle Aged, Primary Health Care, Social Support, Telephone, United States, Cluster Analysis, Remote Consultation

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