, Volume 16, Issue 3, pp 143-149

Improving depression outcomes in community primary care practice

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Abstract

OBJECTIVE: To determine whether redefining primary care team roles would improve outcomes for patients beginning a new treatment episode for major depression.

DESIGN: Following stratification, 6 of 12 practices were randomly assigned to the intervention condition. Intervention effectiveness was evaluated by patient reports of 6-month change in 100-point depression symptom and functional status scales.

SETTING: Twelve community primary care practices across the country employing no onsite mental health professional.

PATIENTS: Using two-stage screening, practices enrolled 479 depressed adult patients (73.4% of those eligible); 90.2% completed six-month follow-up.

INTERVENTION: Two primary care physicians, one nurse, and one administrative staff member in each intervention practice received brief training to improve the detection and management of major depression.

MAIN RESULTS: In patients beginning a new treatment episode, the intervention improved depression symptoms by 8.2 points (95% confidence interval [CI], 0.2 to 16.1; P=.04). Within this group, the intervention improved depression symptoms by 16.2 points (95% CI, 4.5 to 27.9; P=.007), physical role functioning by 14.1 points (95% CI, 1.1 to 29.2; P=.07), and satisfaction with care (P=.02) for patients who reported antidepressant medication was an acceptable treatment at baseline. Patients already in treatment at enrollment did not benefit from the intervention.

CONCLUSIONS: In practices without onsite mental health professionals, brief interventions training primary care teams to assume redefined roles can significantly improve depression outcomes in patients beginning a new treatment episode. Such interventions should target patients who report that antidepressant medication is an acceptable treatment for their condition. More research is needed to determine how primary care teams can best sustain these redefined roles over time.

An earlier version of this study was presented at the 12th International National Institute of Mental Health Conference on Mental Health Problems in the General Health Sector, Baltimore, Md, July 1998.
This research was supported by NIMH grants R01 MH54444 and P50 MH48197 and by a grant from the John D. and Catherine T. MacArthur Foundation.