Stepped collaborative care for primary care patients with persistent symptoms of depression - A randomized trial

Background: Despite improvements in the accuracy of diagnosing depression a nd use of medications with fewer side effects, many patients treated with a ntidepressant medications by primary care physicians have persistent sympto ms. Methods: A group of 228 patients recognized as depressed by their primary c are physicians and given antidepressant medication who had either 4 or more persistent major depressive symptoms or a score of 1.5 or more on the Hopk ins Symptom Checklist depression items at 6 to 8 weeks were randomized to a collaborative care intervention (n = 114) or usual care (n = 114) by the p rimary care physician. Patients in the intervention group received enhanced education and increased frequency of visits by a psychiatrist working with the primary care physician to improve pharmacologic treatment. Follow-up a ssessments were completed at 1, 3, and 6 months by a telephone survey team blinded to randomization status. Results: Those in the intervention group had significantly greater adherenc e to adequate dosage of medication for 90 days or more and were more likely to rate the quality of care they received for depression as good to excell ent compared with usual care controls. Intervention patients showed a signi ficantly greater decrease compared with usual care controls in severity of depressive symptoms over time and were more likely to have fully recovered at 3 and 6 months. Conclusions: A multifaceted program targeted to patients whose depressive s ymptoms persisted 6 to 8 weeks after initiation of antidepressant medicatio n by their primary care physician was found to significantly improve adhere nce to antidepressants, satisfaction with care, and depressive outcomes com pared with usual care.