Telephone management improves outcomes for people beginning antidepressant treatmentRandomised trial of monitoring, feedback, and management of care by telephone to improve treatment of depression in primary care.
- Peveler, Robert
- Simon, GE
- VonKorff, M
- Rutter, C
- Wagner, E
BACKGROUND
The overall management of depression in primary care often does not result in adequate drug treatment or satisfactory outcome.
OBJECTIVE
Comparison of usual care and two systems for managing people with acute depression in a primary care setting.
SETTING
Five primary care clinics in Seattle, Washington, USA.
METHOD
Randomised controlled trial with intention to treat analysis.
LITERATURE REVIEW
No explicit strategy; 24 references.
PARTICIPANTS
Six hundred and thirteen people beginning treatment for depression.
INTERVENTIONS
Usual care versus feedback only versus feedback with care management. Feedback involved a detailed report at 8 and 16 weeks, which included detailed reports on prescriptions and visits, with an algorithm-based treatment recommendation for each participant. Care management involved systematic follow-up of participants by telephone; individually tailored recommendations based on the reports of the telephone conversations; and support from a care manager.
MAIN OUTCOMES
Antidepressant prescription rates; symptom score (Hopkins symptom checklist and DSM-IV structured interview); visits; and cost analysis at 6 months follow-up.
MAIN RESULTS
Feedback alone did not significantly affect prescription patterns or clinical outcomes compared with usual care. Feedback plus care management increased the probability of receiving moderate doses of antidepressant and of increasing depression scores by 50% compared with usual care (OR to receive moderate dose of antidepressant, care management versus usual care 1.99, 95% CI 1.23 to 3.22; OR for 50% improvement in depression score, care management versus usual care 2.22, 95% CI 1.31 to 3.75). Feedback plus care management lowered the probability of major depression compared with usual care (OR for major depression 0.46, 95% CI 0.24 to 0.86). Feedback plus care management increased cost by about £50 (about $75) per person treated, compared with usual care.
AUTHORS' CONCLUSIONS
The system of care management and feedback significantly improved outcomes compared with usual care in people treated for depression in a primary care setting, with a limited increase in cost.