Impact of a primary care quality improvement intervention on use of psychotherapy for depression.

Abstract

We examine the impact of the two Partners in Care (PIC) primary care quality improvement (QI) interventions on counseling services. The QI interventions aimed to increase service use, and thereby improve outcomes, and have been shown to indeed improve patient outcomes (e.g., K. B. Wells et al., 2000). But whether or not use of counseling services actually increased has not yet been examined. The QI interventions contained many overlapping elements; however, QI-Therapy emphasized cognitive-behavioral therapy, and QI-Meds emphasized medications and case management. QI-Therapy patients used more counseling than UC patients at 6 months, though increases were modest. Some treatment effects persisted until 12 months, but not beyond. QI-Therapy and QI-Meds patients reported more treatment overall (therapy or medication) than UC patients at 6 months, and this effect persisted in the QI-Meds clinics until 12 months. Treatment effects were more pronounced among those most in need. Despite high rates of referral to psychotherapy within the QI-Therapy clinics (81%), only a minority of patients actually attended a psychotherapy session within the study (30%). We discuss the uptake of therapy in this study as a way to inform future efforts at QI.