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
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.
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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