Two-year effects of quality improvement programs on medication management for depression

Arch Gen Psychiatry. 2001 Oct;58(10):935-42. doi: 10.1001/archpsyc.58.10.935.


Background: Significant underuse of evidence-based treatments for depression persists in primary care. We examined the effects of 2 primary care-based quality improvement (QI) programs on medication management for depression.

Methods: A total of 1356 patients with depressive symptoms (60% with depressive disorders and 40% with subthreshold depression) from 46 primary care practices in 6 nonacademic managed care organizations were enrolled in a randomized controlled trial of QI for depression. Clinics were randomized to usual care or to 1 of 2 QI programs that involved training of local experts who worked with patients' regular primary care providers (physicians and nurse practitioners) to improve care for depression. In the QI-medications program, depression nurse specialists provided patient education and assessment and followed up patients taking antidepressants for up to 12 months. In the QI-therapy program, depression nurse specialists provided patient education, assessment, and referral to study-trained psychotherapists.

Results: Participants enrolled in both QI programs had significantly higher rates of antidepressant use than those in the usual care group during the initial 6 months of the study (52% in the QI-medications group, 40% in the QI-therapy group, and 33% in the usual care group). Patients in the QI-medications group had higher rates of antidepressant use and a reduction in long-term use of minor tranquilizers for up to 2 years, compared with patients in the QI-therapy or usual care group.

Conclusions: Quality improvement programs for depression in which mental health specialists collaborate with primary care providers can substantially increase rates of antidepressant treatment. Active follow-up by a depression nurse specialist in the QI-medications program was associated with longer-term increases in antidepressant use than in the QI model without such follow-up.

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

  • Adult
  • Anti-Anxiety Agents / therapeutic use
  • Antidepressive Agents / therapeutic use*
  • Depressive Disorder / drug therapy*
  • Depressive Disorder / therapy
  • Evidence-Based Medicine / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Logistic Models
  • Male
  • Managed Care Programs / organization & administration
  • Managed Care Programs / standards
  • Nurse Practitioners / statistics & numerical data
  • Patient Education as Topic
  • Physicians, Family / statistics & numerical data
  • Practice Guidelines as Topic
  • Primary Health Care / methods
  • Primary Health Care / standards*
  • Psychotherapy / methods
  • Psychotherapy / standards
  • Quality Assurance, Health Care / methods*
  • Secondary Prevention
  • Treatment Outcome
  • Workforce


  • Anti-Anxiety Agents
  • Antidepressive Agents