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Am Fam Physician. 2006;74(12):2103

Approximately one in 10 primary care patients has major depression. Intensive, collaborative interventions have been shown to be effective, but they are impractical to implement in many primary care settings. Dobscha and associates studied a less-intensive decision support intervention to determine its effectiveness in improving outcomes in primary care patients with depression.

Overall, 41 health care professionals from five primary care clinics and 375 veterans with depression were included in the study. The health care professionals were invited to two four-hour education programs about communication skills and depression knowledge. After completing the sessions, they were eligible for randomization to treat patients as part of a depression decision support team or to provide usual care only.

In the support group, a care manager supervised by a psychiatrist attempted to call each patient in the group to provide education, explore barriers, emphasize adherence, and encourage communication with the patient’s health care professional. Educational materials were mailed, and patients were invited to attend a group education program.

A research team reviewed charts and collected scores on the Patient Health Questionnaire (PHQ-9, used in primary care settings in screening for and assessment of depression) at one, three, six, nine, and 12 months. The research team also collected data from medical records, including information about medications and appointments. The care manager mailed a quarterly progress report to the health care professional and followed up if the health care professional did not respond to PHQ-9 scores higher than 15 or if the patient’s scores did not improve sufficiently. The care manager also offered consultation and facilitated referrals to a psychiatrist.

Health care professionals in the usual care group received only baseline PHQ-9 scores. They had access to subsequent PHQ-9 data in the patient’s chart and to mental health referral sources.

Follow-up data were completed on 76 percent of enrolled patients with no significant difference between groups. The authors conclude that although depression decision support intervention results in higher recognition and treatment of depression and improves patient satisfaction, it does not improve patient depression severity or quality of life compared with usual care.

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