Quality Improvement Programs For Depression Research Articles

How Quality Improvement Interventions for Depression Affect Stigma Concerns Over Time: A Nine-Year Follow-Up Study

This study examined the long-term impact on stigma concerns of two quality improvement (QI) interventions for depression in primary care. Data were from a nine-year follow-up of 805 participants in Partners in Care, a group-level randomized trial comparing patients enrolled in interventions with enhanced resources for therapy (QI-therapy) (N=284) or medication management (QI-meds) (N=267) with those in usual care (N=254). Participants were asked about stigma in regard to friends, health insurance, and employers. Individuals in QI-therapy were significantly less likely than those in usual care and QI-meds to report concerns about friends learning about a history of depression (odds ratio [OR]=.66 and .65, respectively), and those in QI-meds were more likely than those in QI-therapy and usual care to have concerns about getting insurance (OR=1.42 and 1.68, respectively). Quality improvement programs for depression can raise or lower stigma concerns, depending on program design and resources for specific treatments.

How Quality Improvement Interventions for Depression Affect Stigma Concerns Over Time: A Nine-Year Follow-Up Study

This study examined the long-term impact on stigma concerns of two quality improvement (QI) interventions for depression in primary care. Data were from a nine-year follow-up of 805 participants in Partners in Care, a group-level randomized trial comparing patients enrolled in interventions with enhanced resources for therapy (QI-therapy) (N=284) or medication management (QI-meds) (N=267) with those in usual care (N=254). Participants were asked about stigma in regard to friends, health insurance, and employers. Individuals in QI-therapy were significantly less likely than those in usual care and QI-meds to report concerns about friends learning about a history of depression (odds ratio [OR]=.66 and .65, respectively), and those in QI-meds were more likely than those in QI-therapy and usual care to have concerns about getting insurance (OR=1.42 and 1.68, respectively). Quality improvement programs for depression can raise or lower stigma concerns, depending on program design and resources for specific treatments.

Improving Care for Depression in Patients With Comorbid Substance Misuse

The authors investigated whether quality improvement programs for depression would be effective among substance misusers and whether there would be a differential program-by-comorbidity effect. A group-level randomized controlled trial (Partners in Care) compared two quality improvement programs for depression with usual care. Consecutive patients (N=27,332) from six managed care organizations in five states were screened, and 1,356 were enrolled: 443 received usual care while the rest entered a quality improvement program involving either medication (N=424) or therapy (N=489). Multiple logistic regression was used to test hypotheses and compute standardized predictions of the adjusted rates of depression and use of psychotherapy and antidepressants. Under usual care conditions, depressed patients with substance misuse had an increased probability of ongoing depression despite higher rates of overall appropriate treatment. Among clients with comorbid substance misuse, the quality improvement programs were associated with improved depression outcomes at 12 months and increased antidepressant use at 6 months. Among clients with no substance misuse, the quality improvement programs improved depression outcomes at 6 months and were associated with increased treatment utilization. Co-occurring substance misuse is associated with depression and with increased risk for poorer depression treatment outcomes under usual care conditions. Quality improvement programs can significantly reduce the likelihood of probable depressive disorders in depressed patients with and without comorbid substance misuse. No consistent evidence was found for a differential program-by-comorbidity effect except for a suggestion of greater increase in psychotherapy among individuals with no substance misuse.

Quality Improvement for Depression in Primary Care: Do Patients With Subthreshold Depression Benefit in the Long Run?

Quality improvement programs for depression can improve outcomes, but the utility of including patients with subthreshold depression in quality improvement programs is unclear. The authors examined 57-month effects of quality improvement on clinical outcomes and mental health care utilization of primary care patients with depressive disorder and subthreshold depression. In a group-level, randomized, controlled trial, 46 primary care clinics were randomly assigned to provide usual care or care with a quality improvement intervention that included provider training and other resources for either medication management (medications quality improvement) or evidence-based psychotherapy (therapy quality improvement). Among 1,356 enrolled depressed patients, 991 completed the 57-month follow-up interview (604 patients with depressive disorder and 387 with subthreshold depression). Outcomes measured at 57 months were presence of probable depressive disorder, unmet need for appropriate care (untreated probable disorder), and mental health care utilization in the prior 6 months. Among patients with subthreshold depression at baseline, those seen in clinics with quality improvement programs with special resources for therapy were less likely to have probable depressive disorder and unmet need for care at follow-up, compared with those seen in clinics that provided usual care. Among patients with depressive disorder at baseline, those seen in clinics with quality improvement programs with special resources for medication management were less likely to have unmet need for care at follow-up, compared with those seen in clinics that provided usual care. Patients with subthreshold depression at baseline seen in clinics with a quality improvement intervention were less likely at follow-up to have had a mental health visit (in primary care or specialty care, depending on the intervention) in the prior 6 months. Relative to usual care, quality improvement interventions improved 57-month outcomes (probable depression, unmet need, or both) for primary care patients with depressive disorder and subthreshold depression and lowered use of mental health visits for those with subthreshold depression. The results highlight the feasibility and utility of including patients with subthreshold depression in such programs.

Quality improvement programmes were effective for depression in managed primary care

Wells KB, Sherbourne C, Schoenbaum M, et al. Impact of disseminating quality improvement programs for depression in managed primary care: a randomized controlled trial. JAMA2000 Jan 12; 283 : 212...

Quality Improvement Programs for Depression Make a Difference

Depression is a syndrome that is notorious for being underdiagnosed and undertreated. Investigators used this randomized trial to test the impact of