Current Psychiatry Reports

, Volume 14, Issue 4, pp 370–375 | Cite as

Feasible Evidence-Based Strategies to Manage Depression in Primary Care

  • Benji T. Kurian
  • Bruce Grannemann
  • Madhukar H. Trivedi
Psychiatry in Primary Care (BN Gaynes, Section Editor)

Abstract

According to the World Health Organization, major depressive disorder (MDD) is a leading cause of disability-adjusted life years worldwide. However, recent evidence suggests depression remains undertreated in primary care settings. Measurement-based care (MBC) is an evidence-based strategy that can feasibly assist primary care physicians in managing patients with MDD. Utilizing health information technology tools, such as computer decision support software, can improve adherence to evidence-based treatment guidelines and MBC at the point of care.

Keywords

Depression Primary care Evidence-based guidelines Measurement-based care Clinical assessments Clinical decision support systems Electronic health records Barriers to implementation Residual symptoms Patient-centered outcomes Suicidal ideation Suicide-related behavior Medication side effect Medication adherence Treatment Remission Computer decision support systems 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Kessler RC, Berglund P, Demler O, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289:3095–105.PubMedCrossRefGoogle Scholar
  2. 2.
    Murray CJ, Lopez AD. Evidence-based health policy—lessons from the Global Burden of Disease Study. Science. 1996;274:740–3.PubMedCrossRefGoogle Scholar
  3. 3.
    Karasz A, Dowrick C, Byng R, et al. What we talk about when we talk about depression: doctor-patient conversations and treatment decision outcomes. Br J Gen Pract. 2012;62:55–63.CrossRefGoogle Scholar
  4. 4.
    Trivedi MH, Claassen CA, Grannemann BD, et al. Assessing physicians' use of treatment algorithms: Project IMPACTS study design and rationale. Contemp Clin Trial. 2007;28:192–212.CrossRefGoogle Scholar
  5. 5.
    Trivedi MH, Kern JK, Grannemann BD, Altshuler KZ, Sunderajan P. A computerized clinical decision support system as a means of implementing depression guidelines. Psychiatr Serv. 2004;55:879–85.PubMedCrossRefGoogle Scholar
  6. 6.
    Bakish D. New standard of depression treatment: remission and full recovery. J Clin Psychiatry. 2001;62(Suppl 26):5–9.PubMedGoogle Scholar
  7. 7.
    Judd LL, Akiskal HS, Maser JD, et al. Major depressive disorder: a prospective study of residual subthreshold depressive symptoms as predictor of rapid relapse. J Affect Disord. 1998;50:97–108.PubMedCrossRefGoogle Scholar
  8. 8.
    Jaeger J, Berns S, Uzelac S, Davis-Conway S. Neurocognitive deficits and disability in major depressive disorder. Psychiatry Res. 2006;145:39–48.PubMedCrossRefGoogle Scholar
  9. 9.
    Paykel ES, Ramana R, Cooper Z, Hayhurst H, Kerr J, Barocka A. Residual symptoms after partial remission: an important outcome in depression. Psychol Med. 1995;25:1171–80.PubMedCrossRefGoogle Scholar
  10. 10.
    Gaynes BN, Rush AJ, Trivedi MH, Wisniewski SR, Spencer D, Fava M. The STAR*D study: treating depression in the real world. Cleve Clin J Med. 2008;75:57–66.PubMedCrossRefGoogle Scholar
  11. 11.
    Biggs MM, Shores-Wilson K, Rush AJ, et al. A comparison of alternative assessments of depressive symptom severity: a pilot study. Psychiatry Res. 2000;95:55–65.PubMedCrossRefGoogle Scholar
  12. 12.
    Trivedi MH, Rush AJ, Gaynes BN, et al. Maximizing the adequacy of medication treatment in controlled trials and clinical practice: STAR*D measurement-based care. Neuropsychopharmacology. 2007;32:2479–89.PubMedCrossRefGoogle Scholar
  13. 13.
    Trivedi MH, Rush AJ, Wisniewski SR, et al. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry. 2006;163:28–40.PubMedCrossRefGoogle Scholar
  14. 14.
    •• Morris DW, Trivedi MH. Measurement-based care for unipolar depression. Curr Psychiatry Rep. 2011;13:446–58. This is an updated review of the principles and guidelines behind the use of MBC for depression, and includes patient self-report data for suicidal risk and associated symptoms.PubMedCrossRefGoogle Scholar
  15. 15.
    Trivedi MH, Daly EJ. Measurement-based care for refractory depression: a clinical decision support model for clinical research and practice. Drug Alcohol Depend. 2007;88 Suppl 2:S61–71.PubMedCrossRefGoogle Scholar
  16. 16.
    Rush AJ, Bernstein IH, Trivedi MH, et al. An evaluation of the quick inventory of depressive symptomatology and the hamilton rating scale for depression: a sequenced treatment alternatives to relieve depression trial report. Biol Psychiatry. 2006;59:493–501.PubMedCrossRefGoogle Scholar
  17. 17.
    Rush AJ, Trivedi MH, Ibrahim HM, et al. The 16-item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression. Biol Psychiatry. 2003;54:573–83.PubMedCrossRefGoogle Scholar
  18. 18.
    Trivedi MH, Rush AJ, Ibrahim HM, et al. The Inventory of Depressive Symptomatology, Clinician Rating (IDS-C) and Self-Report (IDS-SR), and the Quick Inventory of Depressive Symptomatology, Clinician Rating (QIDS-C) and Self-Report (QIDS-SR) in public sector patients with mood disorders: a psychometric evaluation. Psychol Med. 2004;34:73–82.PubMedCrossRefGoogle Scholar
  19. 19.
    Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13.PubMedCrossRefGoogle Scholar
  20. 20.
    Arnau RC, Meagher MW, Norris MP, Bramson R. Psychometric evaluation of the Beck Depression Inventory-II with primary care medical patients. Health Psychol. 2001;20:112–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Riskind JH, Beck AT, Brown G, Steer RA. Taking the measure of anxiety and depression. Validity of the reconstructed Hamilton scales. J Nerv Ment Dis. 1987;175:474–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Buysse DJ, Reynolds 3rd CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193–213.PubMedCrossRefGoogle Scholar
  23. 23.
    Trivedi MH, Wisniewski SR, Morris DW, et al. Concise Health Risk Tracking scale: a brief self-report and clinician rating of suicidal risk. J Clin Psychiatry. 2011;72:757–64.PubMedCrossRefGoogle Scholar
  24. 24.
    Trivedi MH, Wisniewski SR, Morris DW, et al. Concise Associated Symptoms Tracking scale: a brief self-report and clinician rating of symptoms associated with suicidality. J Clin Psychiatry. 2011;72:765–74.PubMedCrossRefGoogle Scholar
  25. 25.
    Wisniewski SR, Rush AJ, Balasubramani GK, Trivedi MH, Nierenberg AA. Self-rated global measure of the frequency, intensity, and burden of side effects. J Psychiatr Pract. 2006;12:71–9.PubMedCrossRefGoogle Scholar
  26. 26.
    Levine J, Schooler NR. SAFTEE: a technique for the systematic assessment of side effects in clinical trials. Psychopharmacol Bull. 1986;22:343–81.PubMedGoogle Scholar
  27. 27.
    Kwon A, Bungay KM, Pei Y, et al. Antidepressant use: concordance between self-report and claims records. Med Care. 2003;41:368–74.PubMedGoogle Scholar
  28. 28.
    Committee on Quality of Health Care in America IoM. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: Institute of Medicine; 2001.Google Scholar
  29. 29.
    Kanouse DE, Winkler JD, Kosecoff J, et al. Changing medical practice through technology assessment: an evaluation of the NIH Consensus Development Program. Santa Monica, CA: RAND; 1989.Google Scholar
  30. 30.
    Lomas J, Anderson GM, Domnick-Pierre K, Vayda E, Enkin MW, Hannah WJ. Do practice guidelines guide practice? The effect of a consensus statement on the practice of physicians. N Engl J Med. 1989;321:1306–11.PubMedCrossRefGoogle Scholar
  31. 31.
    Woolf SH. Practice guidelines: a new reality in medicine. III. Impact on patient care. Arch Int Med. 1993;153:2646–55.CrossRefGoogle Scholar
  32. 32.
    Berlowitz DR, Ash AS, Glickman M, et al. Developing a quality measure for clinical inertia in diabetes care. Health Serv Res. 2005;40:1836–53.PubMedCrossRefGoogle Scholar
  33. 33.
    Phillips LS, Branch WT, Cook CB, et al. Clinical inertia. Ann Int Med. 2001;135:825–34.PubMedGoogle Scholar
  34. 34.
    Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effective Practice and Organization of Care Review Group. BMJ. 1998;317:465–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Cabana MD, Rand CS, Powe NR, et al. Why don't physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282:1458–65.PubMedCrossRefGoogle Scholar
  36. 36.
    • Kurian BT, Trivedi MH, Grannemann BD, Claassen CA, Daly EJ, Sunderajan P. A computerized decision support system for depression in primary care. J Clin Psychiatry. 2009;11:140–6. This is a relevant study that assessed the impact of a computer decision support software for treating depression in primary care.Google Scholar
  37. 37.
    Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-management of chronic disease in primary care. JAMA. 2002;288:2469–75.PubMedCrossRefGoogle Scholar
  38. 38.
    Garg AX, Adhikari NK, McDonald H, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA. 2005;293:1223–38.PubMedCrossRefGoogle Scholar
  39. 39.
    • Haynes RB, Wilczynski NL. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: methods of a decision-maker-researcher partnership systematic review. Implement Sci. 2010;5:12. An updated review of their comprehensive 2005 review of implementing CDSSs and barriers associated with implementation.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Benji T. Kurian
    • 1
  • Bruce Grannemann
    • 1
  • Madhukar H. Trivedi
    • 1
  1. 1.Department of PsychiatryUniversity of Texas Southwestern Medical CenterDallasUSA

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