A primary care intervention for depression

To assess a guideline-based intervention's impact on depression cave provid ed in rural vs. urban primary care settings, 12 community primary care prac tices (four rural, eight urban) were randomized to enhanced (i.e, intervent ion) and usual cave study conditions. The study enrolled 479 depressed pati ents, with 432 (90.2 percent) completing telephone followup at six months. Multilevel analytic models revealed Mat rural enhanced care patients had 2. 70 times the odds (P=0.02) of rural usual cave patients of taking a three-m onth course of antidepressant medication at recommended dosages in the six months following baseline; urban enhanced care patients had 2.43 rimes the odds compared with their urban usual care counterparts (P=0.007). Rural enh anced care patients had 3.00 times the odds of rural usual cave patients of making eight or more visits to a mental health specialist fbr counseling i n the six months following baseline (P=0.03). Comparisons of patients in en hanced care practices showed that rural enhanced care patients had 2.00 rim es the odds (P=0.12) of urban enhanced care patients of making at least one visit to a mental health specialist for counseling in the six months follo wing baseline and had comparable odds to urban enhanced care patients (odds ratio [OR]=1.06, P=0.77) of making eight or more visits to such specialist s during that interval. The study intervention improved the care received b y both rural and urban depressed primary care patients. Moreover, the inter ventions effect appears to have been greater in rural settings, particularl y in terms of increasing depressed rural patients' use of mental health spe cialists for counseling.