Effectiveness of a Quality Improvement Intervention for Adolescent Depression in Primary Care Clinics: A Randomized Controlled Trial
CONTEXT Depression is a common condition associated with significant morbidity in adolescents. Few depressed adolescents receive effective treatment for depression in primary care settings. OBJECTIVE To evaluate the effectiveness of a quality improvement intervention aimed at increasing access to ev...
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Published in | JAMA : the journal of the American Medical Association Vol. 293; no. 3; pp. 311 - 319 |
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Main Authors | , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Chicago, IL
American Medical Association
19.01.2005
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Subjects | |
Online Access | Get full text |
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Summary: | CONTEXT Depression is a common condition associated with significant morbidity
in adolescents. Few depressed adolescents receive effective treatment for
depression in primary care settings. OBJECTIVE To evaluate the effectiveness of a quality improvement intervention
aimed at increasing access to evidence-based treatments for depression (particularly
cognitive-behavior therapy and antidepressant medication), relative to usual
care, among adolescents in primary care practices. DESIGN, SETTING, AND PARTICIPANTS Randomized controlled trial conducted between 1999 and 2003 enrolling
418 primary care patients with current depressive symptoms, aged 13 through
21 years, from 5 health care organizations purposively selected to include
managed care, public sector, and academic medical center clinics in the United
States. INTERVENTION Usual care (n = 207) or 6-month quality improvement intervention
(n = 211) including expert leader teams at each site, care managers
who supported primary care clinicians in evaluating and managing patients’
depression, training for care managers in manualized cognitive-behavior therapy
for depression, and patient and clinician choice regarding treatment modality.
Participating clinicians also received education regarding depression evaluation,
management, and pharmacological and psychosocial treatment. MAIN OUTCOME MEASURES Depressive symptoms assessed by Center for Epidemiological Studies-Depression
Scale (CES-D) score. Secondary outcomes were mental health–related quality
of life assessed by Mental Health Summary Score (MCS-12) and satisfaction
with mental health care assessed using a 5-point scale. RESULTS Six months after baseline assessments, intervention patients, compared
with usual care patients, reported significantly fewer depressive symptoms
(mean [SD] CES-D scores, 19.0 [11.9] vs 21.4 [13.1]; P = .02),
higher mental health–related quality of life (mean [SD] MCS-12 scores,
44.6 [11.3] vs 42.8 [12.9]; P = .03), and
greater satisfaction with mental health care (mean [SD] scores, 3.8 [0.9]
vs 3.5 [1.0]; P = .004). Intervention patients
also reported significantly higher rates of mental health care (32.1% vs 17.2%, P<.001) and psychotherapy or counseling (32.0% vs 21.2%, P = .007). CONCLUSIONS A 6-month quality improvement intervention aimed at improving access
to evidence-based depression treatments through primary care was significantly
more effective than usual care for depressed adolescents from diverse primary
care practices. The greater uptake of counseling vs medication under the intervention
reinforces the importance of practice interventions that include resources
to enable evidence-based psychotherapy for depressed adolescents. |
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Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 ObjectType-News-3 content type line 23 |
ISSN: | 0098-7484 1538-3598 |
DOI: | 10.1001/jama.293.3.311 |