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Researchers examine effects of quality improvement on depression care for adolescents and adults

From 15 to 20 percent of adolescents will experience major depression at some point. Improving access to effective treatment for adolescent depression in primary care settings leads to better patient outcomes, according to a recent study. A second study shows that depression is diagnosed much more often among women than men. Both studies show that when adolescents and adults are given better access to medication and therapy through a primary care quality improvement program for depression, quality of care and outcomes are improved relative to usual care. The studies, which are summarized here, were supported in part by the Agency for Healthcare Research and Quality.

Asarnow, J.R., Jaycox, L.H., Duan, N., and others (2005, January). "Effectiveness of a quality improvement intervention for adolescent depression in primary care clinics." (AHRQ grant HS09908). Journal of the American Medical Association 293(3), pp. 311-319.

The researchers conducted a randomized controlled trial between 1999 and 2003 involving 418 primary care patients with depressive symptoms, aged 13 through 21 years, from five health care organizations. The organizations included managed care, public clinics, and academic medical center clinics in the United States. Subjects were randomized to quality improvement (QI) care or usual care (UC). QI care included expert leader teams at each practice site, care managers who supported primary care clinicians in evaluating and managing patients' depression, training for care managers in cognitive behavior therapy for depression, and patient and clinician choice of treatment options, including medication and/or therapy. The research team studied depressive symptoms after 6 months of care for the UC group (207) and the QI group (211).

Six months after initial assessments, QI patients reported significantly fewer depressive symptoms than UC patients (19 vs. 21.4), higher mental health-related quality of life scores (44.6 vs. 42.8), and greater satisfaction with mental health care (3.8 vs. 3.5 on a 5-point scale). QI patients also had higher rates of mental health care (32 vs. 17 percent) and psychotherapy or counseling (32 vs. 21 percent).

Sherbourne, C.D., Weiss, R., Duan, N., and others (2004, December). "Do the effects of quality improvement for depression care differ for men and women?" (AHRQ grant HS08349). Medical Care 42(12), pp. 1186-1193.

These researchers randomized 46 primary care practices within 6 managed care organizations to usual care or one of two QI programs: QI-Meds or QI-Therapy. The QI programs supported QI teams, provider training, nurse assessment and patient education, and resources to support medication management or psychotherapy. The researchers compared the outcomes of UC and QI for adult men and women (a total of 1,299 primary care patients) who completed at least one of five patient assessment questionnaires during the course of 2 years.

Women were more likely to receive depression care than men over time, whether they were in the UC or QI groups. The effect of QI-Meds on probable depression was delayed for men, but the effect was significantly greater for men than for women. QI-Therapy reduced the likelihood of probable depression equally for men and women. However, QI-Therapy had a greater impact on mental health-related quality of life and work status for men than for women. QI-Meds improved these outcomes for women. The authors conclude that QI programs may need to facilitate access to both medication management and effective psychotherapy to improve depression care for both men and women and reduce male-female differences in outcomes.

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