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Health Serv Res. 2008 Dec;43(6):1952-74. doi: 10.1111/j.1475-6773.2008.00871.x. Epub 2008 Jun 3.

The effects of quality improvement for depression in primary care at nine years: results from a randomized, controlled group-level trial.

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  • 1The RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA.

Abstract

OBJECTIVE:

To examine 9-year outcomes of implementation of short-term quality improvement (QI) programs for depression in primary care.

DATA SOURCES:

Depressed primary care patients from six U.S. health care organizations.

STUDY DESIGN:

Group-level, randomized controlled trial.

DATA COLLECTION:

Patients were randomly assigned to short-term QI programs supporting education and resources for medication management (QI-Meds) or access to evidence-based psychotherapy (QI-Therapy); and usual care (UC). Of 1,088 eligible patients, 805 (74 percent) completed 9-year follow-up; results were extrapolated to 1,269 initially enrolled and living. Outcomes were psychological well-being (Mental Health Inventory, five-item version [MHI5]), unmet need, services use, and intermediate outcomes.

PRINCIPAL FINDINGS:

At 9 years, there were no overall intervention status effects on MHI5 or unmet need (largest F (2,41)=2.34, p=.11), but relative to UC, QI-Meds worsened MHI5, reduced effectiveness of coping and among whites lowered tangible social support (smallest t(42)=2.02, p=.05). The interventions reduced outpatient visits and increased perceived barriers to care among whites, but reduced attitudinal barriers due to racial discrimination and other factors among minorities (smallest F (2,41)=3.89, p=.03).

CONCLUSIONS:

Main intervention effects were over but the results suggest some unintended negative consequences at 9 years particularly for the medication-resource intervention and shifts to greater perceived barriers among whites yet reduced attitudinal barriers among minorities.

PMID:
18522664
[PubMed - indexed for MEDLINE]
PMCID:
PMC2614007
Free PMC Article

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