Cited by 181Mental Health Treatment and AccessPrimary Care and Health OutcomesPsychotherapy Techniques and Applications

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Case Management for Depression by Health Care Assistants in Small Primary Care Practices: A Cluster Randomized Trial

Gensichen, Jochen, von Korff, Michael, Peitz, Monika, Muth, Christiane, Beyer, Martin, Güthlin, Corina, Torge, Marion, Petersen, Juliana J., Rosemann, Thomas, König, Jochem, Gerlach, Ferdinand M., for PRoMPT (PRimary care Monitoring for depressive Patients Trial)·2009·Annals of Internal Medicine

DOI 10.7326/0003-4819-151-6-200909150-00001

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Abstract

BACKGROUND: Case management by health care assistants in small primary care practices provides unclear benefit for improving depression symptoms. OBJECTIVE: To determine whether case management provided by health care assistants in small primary care practices is more effective than usual care in improving depression symptoms and process of care for patients with major depression. DESIGN: Cluster randomized, controlled trial. A central automated system generated the randomization scheme, which was stratified by urban and rural practices; allocation sequence was concealed until groups were assigned. SETTING: 74 small primary care practices in Germany from April 2005 to September 2007. PATIENTS: 626 patients age 18 to 80 years with major depression. INTERVENTION: Structured telephone interview to monitor depression symptoms and support for adherence to medication, with feedback to the family physician. MEASUREMENTS: Depression symptoms at 12 months, as measured by the Patient Health Questionnaire-9 (PHQ-9); secondary outcomes were patient assessment of chronic illness care, adherence to medication, and quality of life. RESULTS: A total of 310 patients were randomly assigned to case management and 316 to usual care. At 12 months, 249 intervention recipients and 278 control patients were assessed; 555 patients were included in a modified intention-to-treat-analysis (267 intervention recipients vs. 288 control patients). Compared with control patients, intervention recipients had lower mean PHQ-9 values in depression symptoms (-1.41 [95% CI, -2.49 to -0.33]; P = 0.014), more favorable assessments of care (3.41 vs. 3.11; P = 0.011), and increased treatment adherence (2.70 vs. 2.53; P = 0.042). Quality-of-life scores did not differ between groups. LIMITATION: Patients, health care assistants, family physicians, and researchers were not blinded to group assignment, and 12-month follow-up of patients was incomplete. CONCLUSION: Case management provided by primary care practice-based health care assistants may reduce depression symptoms and improve process of care for patients with major depression more than usual care. PRIMARY FUNDING SOURCE: German Ministry of Education and Research.

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Authors: Gensichen, J., von Korff, M., Peitz, M., Muth, C., Beyer, M., Güthlin, C., Torge, M., Petersen, J. J., Rosemann, T., König, J., Gerlach, F. M., & Trial), F. P. (. C. M. F. D. P.
Affiliations: Goethe University Frankfurt (DE)
From Friedrich Schiller University, Jena, Germany; Goethe University Frankfurt am Main, Frankfurt am Main, Germany; Group Health Center for Health Studies, Seattle, Washington; University of Zürich, Zürich, Switzerland; and University Mainz, Mainz, Germany.
Corresponding author: Gensichen, Jochen
ORCID: Gensichen, Jochen
Rosemann, Thomas
Venue: Annals of Internal Medicine
Publisher: American College of Physicians
Published: 2009-09-15
Volume: 151
Issue: 6
Pages: 369-378
ISSN: 0003-4819 (ISSN-L)
1539-3704
DOI: 10.7326/0003-4819-151-6-200909150-00001
OpenAlex: W2095843429
Cited by: 181
References: 61
Citations by year: 2026: 1 · 2025: 6 · 2024: 8 · 2023: 8 · 2022: 2 · 2021: 11 · 2020: 4 · 2019: 12 · 2018: 12 · 2017: 12 · 2016: 14 · 2015: 11 · 2014: 19 · 2013: 16 · 2012: 15
FWCI: 19.51
Type: journal article
Language: en
Open access: closed
Licence: www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations: Annals of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords: case management, healthcare assistants, major depressive disorder, primary care, small primary care practices, telephone follow-up, medication adherence, process of care, quality of life, chronic care, PHQ-9
MeSH terms: Adolescent, Adult, Aged, Aged, 80 and over, Allied Health Personnel, Antidepressive Agents, Depressive Disorder, Family Practice, Female, Germany, Humans, Interviews as Topic, Male, Middle Aged, Outcome and Process Assessment, Health Care, Prospective Studies, Quality Assurance, Health Care, Surveys and Questionnaires, Telephone, Case Management, Medication Adherence, Young Adult

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Case Management for Depression by Health Care Assistants in Small Primary Care Practices: A Cluster Randomized Trial

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