Improving depression outcomes in community primary care practice - A randomized trial of the QuEST intervention

OBJECTIVE: To determine whether redefining primary care team roles would im prove outcomes for patients beginning a new treatment episode for major dep ression. DESIGN: Following stratification, 6 of 12 practices were randomly assigned to the intervention condition. Intervention effectiveness was evaluated by patient reports of 6-month change in 100-point depression symptom and funct ional status scales. SETTING: Twelve community primary care practices across the country employi ng no onsite mental health professional. PATIENTS: Using two-stage screening, practices enrolled 479 depressed adult patients (73.4% of those eligible); 90.2% completed six-month follow-up. INTERVENTION: Two primary care physicians, one nurse, and one administrativ e staff member in each intervention practice received brief training to imp rove the detection and management of major depression. MAIN RESULTS: In patients beginning a new treatment episode, the interventi on improved depression symptoms by 8.2 points (95% confidence interval [CI] , 0.2 to 16.1: P=.04), Within this group, the intervention improved depress ion symptoms by 16.2 points (95% CI, 4.5 to 27.9; P =.007), physical role f unctioning by 14.1 points (95% CI, 1.1 to 29.2; P =.07], and satisfaction w ith care (P =.02) for patients who reported antidepressant medication was a n acceptable treatment at baseline. Patients already in treatment at enroll ment did not benefit from the intervention. CONCLUSIONS: In practices without onsite mental health professionals, brief interventions training primary care teams to assume redefined roles can si gnificantly improve depression outcomes in patients beginning a new treatme nt episode. Such interventions should target patients who report that antid epressant medication is an acceptable treatment for their condition. More r esearch is needed to determine how primary care teams can best sustain thes e redefined roles over time.