Randomised trial of monitoring, feedback, and management of care by telephone to improve treatment of depression in primary care

Objective To test the effectiveness of two programmes to improve the treatm ent of acute depression in primary care. Design Randomised trial. Setting Primary care clinics in Seattle. Patients 613 patients starting antidepressant treatment Intervention Patients were randomly assigned to continued usual care or one of two interventions: feedback only and feedback plus care management Feed back only comprised feedback and algorithm based recommendations to doctors on the basis of data from computerised records of pharmacy and visits. Fee dback plus care management included systematic follow up by telephone, soph isticated treatment recommendations, and practice support by a care manager . Main outcome measures Blinded interviews by telephone 3 and 6 months after the initial prescription included a 20 item depression scale from the Hopki ns symptom checklist and the structured clinical interview for the current DSM-IV depression module. Visits, antidepressant prescriptions, and overall use of health care were assessed from computerised records. Results Compared with usual care, feedback only had no significant effect o n treatment received or patient outcomes. Patients receiving feedback plus cafe management had a higher probability of both receiving at least moderat e doses of antidepressants (odds ratio 1.99, 95% confidence interval 1.23 t o 3.22) and a 50% improvement in depression scores on the symptom checklist (2.22, 1.31 to 3.75), lower mean depression scores on the symptom checklis t at follow up, and a lower probability of major depression at follow up (0 .46, 0.24 to 0.86). The incremental cost of feedback plus care management w as about $80 (pound 50) per patient. Conclusions Monitoring and feedback to doctors yielded no significant benef its for patients in primary care starting antidepressant treatment A progra mme of systematic follow up and care management by telephone, however, sign ificantly improved outcomes at modest cost.