Quality improvement for depression enhances long-term treatment knowledge for primary care clinicians

OBJECTIVE: We evaluated the effect of implementing quality improvement (QI) programs for depression, relative to usual care, on primary care clinician s' knowledge about treatment. DESIGN AND METHODS: Matched primary care clinics (46) from seven managed ca re organizations were randomized to usual care (mailed written guidelines o nly) versus one of two QI interventions. Self-report surveys assessed clini cians' knowledge of depression treatments prior to full implementation (Jun e 1996 to March 1997) and 18 months later. We used an intent-to-treat analy sis to examine intervention effects on change in knowledge, controlling for clinician and practice characteristics, and the nested design. PARTICIPANTS: One hundred eighty-one primary care clinicians. INTERVENTIONS: The interventions included institutional commitment to QI, t raining local experts, clinician education, and training nurses for patient assessment and education. One intervention had resources for nurse follow- up on medication use (QI-meds) and the other had reduced copayment for ther apy from trained, local therapists (QI-therapy). RESULTS:Clinicians in the intervention group had greater increases compared with clinicians in the usual care group over 18 months in knowledge of psy chotherapy (by 20% for QI-meds, P = .04 and by 33% for QI-therapy, P = .004 ), but there were no significant increases in medication knowledge. Signifi cant increases in knowledge scores (P = .01) were demonstrated by QI-therap y clinicians but not clinicians in the QI-meds group. Clinicians were expos ed to multiple intervention components. CONCLUSIONS: Dissemination of QI programs for depression in managed, primar y care practices improved clinicians' treatment knowledge over 18 months, b ut breadth of learning was somewhat greater for a program that also include d active collaboration with local therapists.