Outcomes/Effectiveness Research

Patients with depression who receive mental health treatment and are involved in therapeutic decisions are more satisfied with their care

Primary care patients suffering from major depression who are involved in decisions about their care and receive mental health treatment (antidepressants and/or therapy) are more satisfied with their care, concludes a new study. As part of the Quality Improvement for Depression Study, patients with depression were randomized to 108 primary managed care practices around the country to receive either collaborative care or usual care.

Collaborative care focused on active care management, provider education and decision support, and collaboration between primary care and mental health providers. Three-fourths of the sample were women and 30 percent were minority patients. Overall, less than half (43 percent) of patients received appropriate care for depression (25.9 percent received antidepressants, 27.6 percent counseling, and 10.2 percent both). On average, patients rated their provider a 3.3 out of 5 on the shared decisionmaking scale. This scale measured whether physicians involved patients in decisions about their care, gave them a choice of treatments, and explained their health problems to them.

Primary care patients who received mental health care were 1.6 times more likely to be satisfied with their care than those who did not receive such care. Those who shared decisionmaking with their doctors were nearly three times more likely to be satisfied with their care than those who were not involved in decisions. Gender did not seem to affect the relationship between quality of care and patient satisfaction. Also, women were no more likely than men to value shared decisionmaking when assessing their satisfaction with care than men.

The researchers suggest that future research on patients with depression should also assess their satisfaction with access to care, such as ease of getting an appointment, as well as their satisfaction with the office staff and the health plan itself. Their findings were based on analysis of responses to surveys administered to patients in the collaboration and usual care groups at baseline and 6 months later. The study was supported in part by the Agency for Healthcare Research and Quality (HS11407).

More details are in "Effect of mental health care and shared decision making on patient satisfaction in a community sample of patients with depression," by Karen A. Swanson, Sc.M., Roshan Bastani, Ph.D., Lisa V. Rubenstein, M.D., M.S.P.H., and others, in the August 2007 Medical Care Research and Review 64(4), pp. 416-430.

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