Steven K. Dobscha, MD; Kathryn Corson, PhD; David H. Hickam, MD, MPH; Nancy A. Perrin, PhD; Dale F. Kraemer, PhD; Martha S. Gerrity, MD, PhD
Most successful disease management interventions for depression care have required intensive involvement of care managers or mental health specialists.
The authors randomly assigned 41 primary care physicians from 5 clinics to receive either depression decision support or usual care. Depression decision support was provided by a team that included a psychiatrist and a nurse care manager and involved an initial telephone contact, patient education, monthly record review, and sending a progress report to primary care physicians every 3 months. Depression severity improved equally in both groups over 12 months, despite evidence that intervention clinicians delivered more depression-related services.
Decision support improved processes of depression care but not outcomes.
PHQ-9 = Patient Health Questionnaire.
Mean ± SE scores for the intervention group were 1.89 ± 0.05 at baseline, 1.54 ± 0.05 at 6 months, and 1.63 ± 0.06 at 12 months. Mean ± SE scores for the usual care group were 1.92 ± 0.05 at baseline, 1.58 ± 0.06 at 6 months, and 1.62 ± 0.06 at 12 months.
P = 0.019 for initial improvement from baseline (quadratic model), comparing intervention and usual care groups.
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Dobscha SK, Corson K, Hickam DH, Perrin NA, Kraemer DF, Gerrity MS. Depression Decision Support in Primary Care: A Cluster Randomized Trial. Ann Intern Med. 2006;145:477-487. doi: 10.7326/0003-4819-145-7-200610030-00005
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Published: Ann Intern Med. 2006;145(7):477-487.
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