Long-term benefits of short-term quality improvement interventions for depressed youths in primary care

Am J Psychiatry. 2009 Sep;166(9):1002-10. doi: 10.1176/appi.ajp.2009.08121909. Epub 2009 Aug 3.

Abstract

Objective: Quality improvement programs for depressed youths in primary care settings have been shown to improve 6-month clinical outcomes, but longer-term outcomes are unknown. The authors examined 6-, 12-, and 18-month outcomes of a primary care quality improvement intervention.

Method: Primary care patients 13-21 years of age with current depressive symptoms were randomly assigned to a 6-month quality improvement intervention (N=211) or to treatment as usual enhanced with provider training (N=207). The quality improvement intervention featured expert leader teams to oversee implementation of the intervention; clinical care managers trained in cognitive-behavioral therapy for depression to support patient evaluation and treatment; and support for patient and provider choice of treatments.

Results: The quality improvement intervention, relative to enhanced treatment as usual, lowered the likelihood of severe depression (Center for Epidemiological Studies Depression Scale score > or =24) at 6 months; a similar trend at 18 months was not statistically significant. Path analyses revealed a significant indirect intervention effect on long-term depression due to the initial intervention improvement at 6 months.

Conclusions: In this randomized effectiveness trial of a primary care quality improvement intervention for depressed youths, the main effect of the intervention on outcomes was to decrease the likelihood of severe depression at the 6-month outcome assessment. These early intervention-related improvements conferred additional long-term protection through a favorable shift in illness course through 12 and 18 months.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Cognitive Behavioral Therapy / methods*
  • Community Mental Health Services
  • Cost-Benefit Analysis
  • Depressive Disorder / diagnosis
  • Depressive Disorder / therapy*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Outcome Assessment, Health Care
  • Primary Health Care / methods*
  • Primary Health Care / standards
  • Psychiatric Status Rating Scales
  • Quality Assurance, Health Care / methods*
  • Quality Assurance, Health Care / statistics & numerical data*
  • Quality of Life
  • Severity of Illness Index
  • Total Quality Management
  • Treatment Outcome