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Re-engineering systems for the treatment of depression in primary care: cluster randomised controlled trial
Open accessAbstract
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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Metadata
- 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
- PMC
- PMC516659
- 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
- bronze
- doi.org
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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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