Background:
This study is a randomized, controlled trial of a collaborative treatment intervention, Depression Decision Support (DDS). To equip providers with the knowledge and skills necessary to make best use of DDS, providers entering both arms of the study will receive the MacArthur Depression Education Program (DEP). DEP is a previously tested workshop designed to improve providers� treatment of depressed patients. Providers in the intervention group will receive DEP followed by DDS, while control providers will receive DEP followed by usual care support. Providers in the DDS intervention group will receive serial reports of depression severity scores and pharmacy and appointment data for their patients enrolled in the study. The DDS team (psychiatrist and nurse) will review this same information, and make initial recommendations to providers. The DDS nurse will make one telephone contact with each intervention patient early in treatment. Additional time and effort expended by the DDS team will be targeted towards patients not showing improvement in depression severity.
Objectives:
The primary objective of this study is to determine the impact of a low-intensity care management program on outcomes of patients with major depression in the primary care setting. Secondary objectives of the study are to determine: 1) the extent to which primary care providers adhere to VA Major Depression Treatment Guidelines; and 2) the extent to which the care management intervention impacts measures of utilization.
Methods:
Forty-four staff providers and 400 patients at VA clinic sites in the Portland VA will participate. After stratification by discipline and site, providers will be randomized into one of two groups. One group will receive DDS while the other receives usual care (including an on-site mental health team). Patients will be clustered by provider to receive intervention or usual care based on provider assignment. Potential subjects will be contacted by telephone to complete brief screening questionnaires. Patients will be included in the study if they have Patient Health Questionnaire Depression (PHQ) scores >10. There will be no restrictions by age or sex. Patients will be excluded if they have psychotic symptoms, dementia, serious suicidal ideation, very severe depression (PHQ-D >25), or have been treated by mental health clinicians within the previous six months. Patients meeting eligibility criteria will meet in-person or via videoconferencing with research assistants for initial interviews. The intervention will last 12 months. Depression symptom severity (SCL-20 score) and health related quality of life (SF-36V) at 6- and 12-months will be primary outcomes. Secondary outcomes will be measures of VA healthcare utilization, and provider adherence to VA Major Depression Guidelines. The primary analysis will be a comparison of the DDS versus usual care groups using a nested analysis of variance (ANOVA), with patients nested within provider.
Status:
Primary patient data collection has been completed, and we are currently performing main-effects analyses.
Purpose
