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Improved Treatment Program for Depression in Primary Care Settings Improves Patient Outcomes and Employment

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Press Release Date: January 11, 2000

Patients suffering from depression can have higher treatment rates, better health outcomes, and a higher chance of remaining employed for at least a year when treated in primary care practices using a specifically designed quality improvement program. This was the finding of a Patient Outcomes Research Team (PORT) on depression, headed by Kenneth B. Wells, M.D., M.P.H., senior scientist at RAND and professor of psychiatry at UCLA. The study was funded by the Agency for Healthcare Research and Quality (AHRQ) and published in the January 12 issue of Journal of the American Medical Association (JAMA).

Dr. Wells and his colleagues developed and tested evidence-based intervention materials (training guides, slides, brochures and videos) designed for clinicians, nurse specialists, psychotherapists and patients by incorporating them into a quality improvement program. They found that the materials helped manage the depression of 50-60 percent of patients in the test group versus 40-50 percent of the control group (equivalent to a 20-30 percent comparative or relative improvement in quality of care). The program did not require any services beyond those which already were covered by the patients' health plans. In addition, there was a five percent increase in the likelihood patients would still be employed after a year of treatment, showing that overall employment rates can be affected by improved treatment. According to the researchers, this substantial improvement represents an even greater benefit if generalized to the larger population of depressed patients.

The quality improvement program, as used in this study, was a resource tool kit for primary care practices. It offered training and materials for clinicians, staff, and patients about depression, its treatment, and how to better communicate information about the treatment progress. The study found that patients with both severe and mild forms of depression improved their outcomes under the program, and that the program was similarly effective whether it provided extra resources for medication management or for psychotherapy.

"The results of this study show that there are useful and evidence-based strategies that offer better outcomes to depressed patients," said John M. Eisenberg, M.D., Director of AHRQ. "These approaches work today in everyday practice, not just in a controlled environment. This project put evidence-based medicine to work to improve health care quality."

"This is very good news for physicians, practices, and most of all for patients with depression—a condition that specifically undermines the sense of hope,"said Dr. Wells. "Our findings show that practices can be flexible in how they approach improving care for depression, without having to target just sicker patients. They can offer a range of treatments to patients with the expectation that outcomes, including employment retention, will improve."

The researchers wanted to see if using a quality improvement program in managed care primary care practices under natural conditions would improve the quality of care to patients. The study involved 46 primary care clinics in 7 U.S. managed care organizations, which adapted the materials to their own policies. Doctors and patients in the clinics retained full choice over the type of treatment chosen, and payment was provided under the patients' regular coverage. Clinics were community based and chosen to be diverse in geography, organization, demographics, and type of insurance (uninsured patients were included in one site). The researchers also made an effort to oversample Mexican American patients to examine whether they would benefit from the program. Spanish-language materials were developed specifically for this purpose.

Last December, U.S. Surgeon General David Satcher issued the first Surgeon General's report on mental health, which highlighted the prevalence of depression in this country. The report also emphasized the need for quality research to develop evidence-based interventions that have a discernible impact on practice. "This PORT study specifically shows promise for an approach to assessment and care that can make an important difference in filling the unmet need in the community," Dr. Satcher said.

The study, "Impact of Disseminating Quality Improvement Programs for Depression in Managed Primary Care Practices: A Randomized Controlled Trial," is published in JAMA, January 12, 2000, Vol. 283, No. 2, 212-220.

Editor's Notes:

  • Interviews with Dr. Wells can be arranged by calling RAND's Public Information Office, at (310) 451-6913.
  • To order the quality improvement study package, contact RAND Distribution Services by phone at (310) 451-7002, fax at (310) 451-6915, or E-mail (order@rand.org).
  • On December 6, 1999, the Agency for Health Care Policy and Research was renamed the Agency for Healthcare Research and Quality. The Agency, a part of the U.S. Department of Health and Human Services, is leading Federal research efforts to improve the quality of health care, reduce its cost, improve patient safety, address medical errors, and broaden access to essential services.

For more information, please contact AHRQ Public Affairs, (301) 427-1364: Karen Carp, (301) 427-1858 (KCcarp@ahrq.gov); Karen Migdail, (301) 427-1855 (KMigdail@ahrq.gov).

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