The electronic medical record

Background: Inadequate treatments are reported for depressed patients cared for by primary care physicians (PCPs). Providing feedback and evidence-bas ed treatment recommendations for depression to PCPs via electronic medical record improves the quality of interventions. Methods: Patients presenting to an urban academically affiliated primary ca re practice were screened for major depression with the Primary Care Evalua tion of Mental Disorders (PRIME-MD). During 20-month period, 212 patients m et protocol-eligibility criteria and completed a baseline interview. They w ere cared for by 16 board-certified internists, who were electronically inf ormed of their patients' diagnoses, and randomized to 1 of 3 methods of exp osure to guideline-based advice for treating depression (active, passive, a nd usual care). Ensuing treatment patterns were assessed by medical chart r eview and by patient self-report at baseline and 3 months. Results: Median time for PCP response to the electronic message regarding t he patient's depression diagnosis was 1 day (range, 1-95 days). Three days after notification, 120 (65%) of 186 PCP responses indicated agreement with the diagnosis, 24 (13%) indicated disagreement, and 42 (23%) indicated unc ertainty. Primary care physicians who agreed with the diagnoses sooner were more likely to make a medical chart notation of depression, begin antidepr essant medication therapy, or refer to a mental health specialist (P<.001). There were no differences in the agreement rate or treatments provided acr oss guideline exposure conditions. Conclusions: Electronic feedback of the diagnosis of major depression can a ffect PCP initial management of the disorder. Further study is necessary to determine whether this strategy, combined with delivery of treatment recom mendations, can improve clinical outcomes in routine practice.