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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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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