Journal of General Internal Medicine

, Volume 17, Issue 7, pp 493–503

A randomized trial using computerized decision support to improve treatment of major depression in primary care

  • Bruce L. Rollman
  • Barbara H. Hanusa
  • Henry J. Lowe
  • Trae Gilbert
  • Wishwa N. Kapoor
  • Herbert C. Schulberg
Original Articles

DOI: 10.1046/j.1525-1497.2002.10421.x

Cite this article as:
Rollman, B.L., Hanusa, B.H., Lowe, H.J. et al. J GEN INTERN MED (2002) 17: 493. doi:10.1046/j.1525-1497.2002.10421.x

Abstract

OBJECTIVE: To examine whether feedback and treatment advice for depression presented to primary care physicians (PCPs) via an electronic medical record (EMR) system can potentially improve clinical outcomes and care processes for patients with major depression.

DESIGN: Randomized controlled trial.

SETTING: Academically affiliated primary care practice in Pittsburgh, PA.

PATIENTS: Two hundred primary care patients with major depression on the Primary Care Evaluation of Mental Disorders (PRIME-MD) and who met all protocol-eligibility criteria.

INTERVENTION: PCPs were randomly assigned to 1 of 3 levels of exposure to EMR feedback of guideline-based treatment advice for depression: “active care” (AC), “passive care” (PC), or “usual care” (UC).

MEASUREMENTS AND MAIN RESULTS: Patients’ 3- and 6-month Hamilton Rating Scale for Depression (HRS-D) score and chart review of PCP reports of depression care in the 6 months following the depression diagnosis. Only 22% of patients recovered from their depressive episode at 6 months (HRS-D ≤7). Patients’ mean HRS-D score decreased regardless of their PCPs’ guideline-exposure condition (20.4 to 14.2 from baseline to 6-month follow-up; P<.001). However, neither continuous (HRS-D ≤7: 22% AC, 23% PC, 22% UC; P=.8) nor categorical measures of recovery (P=.2) differed by EMR exposure condition upon follow-up. Care processes for depression were also similar by PCP assignment despite exposure to repeated reminders of the depression diagnosis and treatment advice (e.g., depression mentioned in ≥3 contacts with usual PCP at 6 months: 31% AC, 31% PC, 18% UC; P=.09 and antidepressant medication suggested/prescribed or baseline regimen modified at 6 months: 59% AC, 57% PC, 52% UC; P=.3).

CONCLUSIONS: Screening for major depression, electronically informing PCPs of the diagnosis, and then exposing them to evidence-based treatment recommendations for depression via EMR has little differential impact on patients’ 3- or 6-month clinical outcomes or on process measures consistent with high-quality depression care.

Key words

major depressionPRIME-MDprimary careelectronic medical recordsclinical practice guidelinesintervention

Copyright information

© Society of General Internal Medicine 2002

Authors and Affiliations

  • Bruce L. Rollman
    • 1
  • Barbara H. Hanusa
    • 1
  • Henry J. Lowe
    • 2
  • Trae Gilbert
    • 3
  • Wishwa N. Kapoor
    • 1
  • Herbert C. Schulberg
    • 4
  1. 1.the Division of General Internal Medicine, Center for Research on Health CareUniversity of Pittsburgh School of MedicinePittsburgh
  2. 2.the Center for Biomedical Informatics (HJL)University of Pittsburgh School of MedicinePittsburgh
  3. 3.the Department of Psychiatry, Western Psychiatric Institute and ClinicUniversity of Pittsburgh School of MedicinePittsburgh
  4. 4.the Department of Psychiatry, Weill Medical CollegeCornell UniversityWhite Plains
  5. 5.Center for Research on Health CareUniversity of Pittsburgh Medical CenterPittsburgh