Depression Decision Support in Primary Care: A Cluster Randomized Trial

Abstract

Decision support improved processes of care but not depression outcomes. More intensive care management or specialty treatment may be needed to improve depression outcomes.

Screening for Posttraumatic Stress Disorder in VA Primary Care Patients with Depression Symptoms

“…Between January 2002 and September 2003, we recruited clinicians and patients from 5 primary care clinics at 1 VA medical center for a randomized controlled trial of a collaborative intervention for depression in primary care (DEP-PC) 16 . DEP-PC was approved by the medical center's Institutional Review Board, and participating clinicians and patients gave informed consent.…”

A Computerized Decision Support System for Depression in Primary Care

“…37 Of note, however, is that prior studies assessing depression in primary care have included multifaceted treatment interventions in addition to a treatment algorithm (ie, patient education, trained nurses assisting follow-up, and psychiatric consultations). [10][11][12][13] Our results are unique in that this is the first study to assess the impact of a computerized decision support system utilized directly by primary care physicians in the treatment visit (without other care components).…”

Pre-post Evaluation of Automated Reminders May Improve Detection and Management of Post-stroke Depression

“…This is important since as many as half of depressed patients in VA PC use non-VA care for some aspect of their overall healthcare. 37 Although treatment rates we observed in this study are relatively high, other VA studies have noted that duration of antidepressant use and adequacy of follow-up are elements of guideline-adherent depression treatment that may have more room for improvement in VA. [18][19][20] Since other studies of decision support interventions for depression care have also generally shown improvement in screening but less impact on treatment, [38][39][40] added systems changes such as care manager support may be necessary to improve depression treatment processes and outcomes. 35 Finally, as an implementation study with local tailoring, only one site successfully implemented the reminders in both neurology and PC clinics.…”