The effects of quality improvement for depression in primary care at nine years: Results from a randomized, controlled group-level trial Article

Wells, KB, Tang, L, Miranda, J et al. (2008). The effects of quality improvement for depression in primary care at nine years: Results from a randomized, controlled group-level trial . HEALTH SERVICES RESEARCH, 43(6), 1952-1974. 10.1111/j.1475-6773.2008.00871.x

cited authors

  • Wells, KB; Tang, L; Miranda, J; Benjamin, B; Duan, N; Sherbourne, CD

authors

abstract

  • Objective. To examine 9-year outcomes of implementation of short-term quality improvement (QI) programs for depression in primary care. Data Sources. Depressed primary care patients from six U.S. health care organizations. Study Design. Group-level, randomized controlled trial. Data Collection. Patients were randomly assigned to short-term QI programs supporting education and resources for medication management (QI-Meds) or access to evidence-based psychotherapy (QI-Therapy); and usual care (UC). Of 1,088 eligible patients, 805 (74 percent) completed 9-year follow-up; results were extrapolated to 1,269 initially enrolled and living. Outcomes were psychological well-being (Mental Health Inventory, five-item version [MHI5]), unmet need, services use, and intermediate outcomes. Principal Findings. At 9 years, there were no overall intervention status effects on MHI5 or unmet need (largest F (2,41)=2.34, p=.11), but relative to UC, QI-Meds worsened MHI5, reduced effectiveness of coping and among whites lowered tangible social support (smallest t(42)=2.02, p=.05). The interventions reduced outpatient visits and increased perceived barriers to care among whites, but reduced attitudinal barriers due to racial discrimination and other factors among minorities (smallest F (2,41)=3.89, p=.03). Conclusions. Main intervention effects were over but the results suggest some unintended negative consequences at 9 years particularly for the medication-resource intervention and shifts to greater perceived barriers among whites yet reduced attitudinal barriers among minorities. © Health Research and Educational Trust.

publication date

  • December 1, 2008

published in

Digital Object Identifier (DOI)

start page

  • 1952

end page

  • 1974

volume

  • 43

issue

  • 6