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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, Lefever, Jean J, Heo, Moonseong, Rost, Kathryn, Kroenke, Kurt, Gerrity, Martha, Nutting, Paul A·2004·BMJ

DOI 10.1136/bmj.38219.481250.55PMC PMC516659

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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
ORCID: Williams, John W
Bruce, Martha L
Raue, Patrick J
Heo, Moonseong
Kroenke, Kurt
Gerrity, Martha
Venue: BMJ
Publisher: BMJ
Published: 2004-09-02
Volume: 329
Issue: 7466
Pages: 602
ISSN: 0007-1447 (ISSN-L)
0959-8138
1468-5833
DOI: 10.1136/bmj.38219.481250.55
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
Licence: www.bmj.org/licenses/tdm/1.0/terms-and-conditions.html (tdm)
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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Re-engineering systems for the treatment of depression in primary care: cluster randomised controlled trial

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