Re-engineering systems for the treatment of depression in primary care: cluster randomised controlled trial

BMJ. 2004 Sep 11;329(7466):602. doi: 10.1136/bmj.38219.481250.55. Epub 2004 Sep 2.


Objective: To test the effectiveness of an evidence based model for management of depression in primary care with support from quality improvement resources.

Design: Cluster randomised controlled trial.

Setting: Five healthcare organisations in the United States and 60 affiliated practices.

Patients: 405 patients, aged > or = 18 years, starting or changing treatment for depression.

Intervention: Care provided by clinicians, with staff providing telephone support under supervision from a psychiatrist.

Main outcome measures: Severity of depression at three and six months (Hopkins symptom checklist-20): response to treatment (> or = 50% decrease in scores) and remission (score of < 0.5).

Results: At six months, 60% (106 of 177) of patients in intervention practices had responded to treatment compared with 47% (68 of 146) of patients in usual care practices (P = 0.02). At six months, 37% of intervention patients showed remission compared with 27% for usual care patients (P = 0.014). 90% of intervention patients rated their depression care as good or excellent at six months compared with 75% of usual care patients (P = 0.0003).

Conclusion: Resources such as quality improvement programmes can be used effectively in primary care to implement evidence based management of depression and improve outcomes for patients with depression.

Publication types

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

MeSH terms

  • Adult
  • Aged
  • Cluster Analysis
  • Community Mental Health Services / organization & administration*
  • Depressive Disorder / therapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Primary Health Care / organization & administration*
  • Remote Consultation
  • Social Support
  • Telephone
  • United States