Designing and implementing a primary care intervention trial to improve the quality and outcome of care for major depression

Gen Hosp Psychiatry. 2000 Mar-Apr;22(2):66-77. doi: 10.1016/s0163-8343(00)00059-1.


Complex interventions, which have been shown to improve primary care depression outcomes, are difficult to disseminate to routine practice settings. To address this problem, we developed a brief intervention to train primary care physicians and nurses employed by the practice to improve the detection and management of major depression. Before recruitment began, the research team conducted academic detailing conference calls with primary care physicians and nurses, and provided in-person training with nurses and administrative staff. Administrative staff screened over 11,000 patients before their visits to identify those with probable major depression. Primary care physicians delegated increased responsibility to office nurses, who educated over 90% of patients about effective depression treatment and systematically monitored their progress over time. Early results demonstrate that community primary care practices can rebundle traditional team roles over the short-term to provide more systematic mental health treatment without adding additional personnel. A rigorous evaluation of this effort will reduce time-consuming, expensive, and often unsuccessful efforts to "translate" research intervention findings into everyday practice.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Depressive Disorder, Major / diagnosis*
  • Depressive Disorder, Major / therapy*
  • Disease Management
  • Education
  • Female
  • Humans
  • Male
  • Nurses*
  • Outcome and Process Assessment, Health Care
  • Patient Selection
  • Practice Patterns, Physicians' / organization & administration*
  • Primary Health Care / organization & administration*
  • Psychiatric Status Rating Scales
  • Research Design
  • Rural Health Services
  • United States
  • Urban Health Services