You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


ABOUT ARCHIVES
Advanced Search

Welcome   | My Account | E-mail Alerts | Access Rights | Sign In


  Vol. 58 No. 7, July 2001 TABLE OF CONTENTS
  Archives
  •  Online Features
  Original Article
 This Article
 •Full text
 •PDF
 • Reply to article
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Citing articles on Web of Science (74)
 •Contact me when this article is cited
 Related Content
 •Similar articles in this journal
 Topic Collections
 •Depression
 •Quality of Care, Other
 •Alert me on articles by topic
 Social Bookmarking
  Add to CiteULike Add to Connotea Add to Del.icio.us Add to Digg Add to Reddit Add to Technorati Add to Twitter What's this?

Long-term Effectiveness of Disseminating Quality Improvement for Depression in Primary Care

Cathy D. Sherbourne, PhD; Kenneth B. Wells, MD,MPH; Naihua Duan, PhD; Jeanne Miranda, PhD; Jürgen Unützer, MD,MPH; Lisa Jaycox, PhD; Michael Schoenbaum, PhD; Lisa S. Meredith, PhD; Lisa V. Rubenstein, MD,MPH

Arch Gen Psychiatry. 2001;58:696-703.

Background  This article addresses whether dissemination of short-term quality improvement (QI) interventions for depression to primary care practices improves patients' clinical outcomes and health-related quality of life (HRQOL) over 2 years, relative to usual care (UC).

Methods  The sample included 1299 patients with current depressive symptoms and 12-month, lifetime, or no depressive disorder from 46 primary care practices in 6 managed care organizations. Clinics were randomized to UC or 1 of 2 QI programs that included training local experts and nurse specialists to provide clinician and patient education, assessment, and treatment planning, plus either nurse care managers for medication follow-up (QI-meds) or access to trained psychotherapists (QI-therapy). Outcomes were assessed every 6 months for 2 years.

Results  For most outcomes, differences between intervention and UC patients were not sustained for the full 2 years. However, QI-therapy reduced overall poor outcomes compared with UC by about 8 percentage points throughout 2 years, and by 10 percentage points compared with QI-meds at 24 months. Both interventions improved patients' clinical and role outcomes, relative to UC, over 12 months (eg, a 10-11 and 6-7 percentage point difference in probable depression at 6 and 12 months, respectively).

Conclusions  While most outcome improvements were not sustained over the full 2 study years, findings suggest that flexible dissemination of short-term, QI programs in managed primary care can improve patient outcomes well after program termination. Models that support integrated psychotherapy and medication-based treatment strategies in primary care have the potential for relatively long-term patient benefits.


From the Health Program, RAND, Santa Monica, Calif (Drs Sherbourne, Wells, Duan, Jaycox, Schoenbaum, Meredith, and Rubenstein); the Neuropsychiatric Institute and Department of Biobehavioral Services, University of California, Los Angeles (Drs Wells, Duan, and Unützer); the Department of Psychiatry, Georgetown University Medical Center, Washington, DC (Dr Miranda); and the Department of Medicine, VA Greater Los Angeles Healthcare System, Sepulveda, Calif (Dr Rubenstein).



Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Wishing Upon a STAR*D: The Promise of Ideal Depression Care by Primary Care Providers
Ong and Rubenstein
Psychiatr. Serv. 2009;60:1460-1462.
ABSTRACT | FULL TEXT  

Incremental Benefit and Cost of Telephone Care Management and Telephone Psychotherapy for Depression in Primary Care
Simon et al.
Arch Gen Psychiatry 2009;66:1081-1089.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of Quality Improvement Programs for Patients With Subthreshold Depression or Depressive Disorder
Wells et al.
Psychiatr. Serv. 2007;58:1269-1278.
ABSTRACT | FULL TEXT  

The Effect of Adherence to Practice Guidelines on Depression Outcomes
Hepner et al.
ANN INTERN MED 2007;147:320-329.
ABSTRACT | FULL TEXT  

Predicting Outcomes of Primary Care Patients With Major Depression: Development of a Depression Prognosis Index
Rubenstein et al.
Psychiatr. Serv. 2007;58:1049-1056.
ABSTRACT | FULL TEXT  

Adolescent Depression Screening in Primary Care: Feasibility and Acceptability
Zuckerbrot et al.
Pediatrics 2007;119:101-108.
ABSTRACT | FULL TEXT  

Collaborative care for depression in primary care: Making sense of a complex intervention: systematic review and meta-regression
Bower et al.
Br. J. Psychiatry 2006;189:484-493.
ABSTRACT | FULL TEXT  

Collaborative Care for Depression: A Cumulative Meta-analysis and Review of Longer-term Outcomes
Gilbody et al.
Arch Intern Med 2006;166:2314-2321.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of a Primary Care Treatment Program for Depression in Low-Income Women in Santiago, Chile
Araya et al.
Am. J. Psychiatry 2006;163:1379-1387.
ABSTRACT | FULL TEXT  

Collaborative Care for Bipolar Disorder: Part II. Impact on Clinical Outcome, Function, and Costs
Bauer et al.
Psychiatr. Serv. 2006;57:937-945.
ABSTRACT | FULL TEXT  

Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care
Hunkeler et al.
BMJ 2006;332:259-263.
ABSTRACT | FULL TEXT  

Bipolar Depression in a Low-Income Primary Care Clinic
Olfson et al.
Am. J. Psychiatry 2005;162:2146-2151.
ABSTRACT | FULL TEXT  

Cost-effectiveness of Evidence-Based Pharmacotherapy or Cognitive Behavior Therapy Compared With Community Referral for Major Depression in Predominantly Low-Income Minority Women
Revicki et al.
Arch Gen Psychiatry 2005;62:868-875.
ABSTRACT | FULL TEXT  

Access to Specialty Mental Health Services Among Women in California
Kimerling and Baumrind
Psychiatr. Serv. 2005;56:729-734.
ABSTRACT | FULL TEXT  

Quality Improvement for Depression in Primary Care: Do Patients With Subthreshold Depression Benefit in the Long Run?
Wells et al.
Am. J. Psychiatry 2005;162:1149-1157.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of Enhancing Primary Care Depression Management on an Ongoing Basis
Rost et al.
Ann Fam Med 2005;3:7-14.
ABSTRACT | FULL TEXT  

RCT of a Care Manager Intervention for Major Depression in Primary Care: 2-Year Costs for Patients With Physical vs Psychological Complaints
Dickinson et al.
Ann Fam Med 2005;3:15-22.
ABSTRACT | FULL TEXT  

Comparing the Quality of Antidepressant Pharmacotherapy in the Department of Veterans Affairs and the Private Sector
Busch et al.
Psychiatr. Serv. 2004;55:1386-1391.
ABSTRACT | FULL TEXT  

The Partners in Care Approach to Ethics Outcomes in Quality Improvement Programs for Depression
Halpern et al.
Psychiatr. Serv. 2004;55:532-539.
ABSTRACT | FULL TEXT  

Five-Year Impact of Quality Improvement for Depression: Results of a Group-Level Randomized Controlled Trial
Wells et al.
Arch Gen Psychiatry 2004;61:378-386.
ABSTRACT | FULL TEXT  

Educational and Organizational Interventions to Improve the Management of Depression in Primary Care: A Systematic Review
Gilbody et al.
JAMA 2003;289:3145-3151.
ABSTRACT | FULL TEXT  

Improving the detection and management of depression in primary care
Gilbody et al.
Qual Saf Health Care 2003;12:149-155.
ABSTRACT | FULL TEXT  

OTHER ARTICLES NOTED (Nov 01 to 18 Oct 02)
Evid. Based Nurs. 2003;6:e1-1.
FULL TEXT  

A Three-Component Model for Reengineering Systems for the Treatment of Depression in Primary Care
Oxman et al.
Psychosomatics 2002;43:441-450.
ABSTRACT | FULL TEXT  

Managing depression as a chronic disease: a randomised trial of ongoing treatment in primary care
Rost et al.
BMJ 2002;325:934-934.
ABSTRACT | FULL TEXT  

Comprehensive Guide to Interpersonal Psychotherapy
Rush
Arch Gen Psychiatry 2002;59:474-475.
FULL TEXT  

Quality Improvement Interventions Improve Depression Outcomes
JWatch Women's Health 2001;2001:8-8.
FULL TEXT  

A Randomized Effectiveness Trial of Collaborative Care for Patients With Panic Disorder in Primary Care
Roy-Byrne et al.
Arch Gen Psychiatry 2001;58:869-876.
ABSTRACT | FULL TEXT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 2001 American Medical Association. All Rights Reserved.