Two-year effects of quality improvement programs on medication management for depression

Background: Significant underuse of evidence-based treatments for depressio n persists in primary care. We examined the effects of 2 primary care-based quality improvement (QI) programs on medication management for depression. Methods: A total of 1356 patients with depressive symptoms (60% with depres sive disorders and 40% with subthreshold depression) from 46 primary care p ractices in 6 nonacademic managed care organizations were enrolled in a ran domized controlled trial of QI for depression. Clinics were randomized to u sual care or to 1 of 2 QI programs that involved training of local experts who worked with patients' regular primary care providers (physicians and nu rse practitioners) to improve care for depression. In the QI-medications pr ogram, depression nurse specialists provided patient education and assessme nt and followed up patients taking antidepressants for up to 12 months. In the QI-therapy program, depression nurse specialists provided patient educa tion, assessment, and referral to study-trained psychotherapists. Results: Participants enrolled in both QI programs had significantly higher rates of antidepressant use than those in the usual care group during the initial 6 months of the study (52% in the QI-medications group, 40% in the QI-therapy group, and 33% in the usual care group). Patients in the QI-medi cations group had higher rates of antidepressant use and a reduction in lon g-term use of minor tranquilizers for up to 2 years, compared with patients in the QI-therapy or usual care group. Conclusions: Quality improvement programs for depression in which mental he alth specialists collaborate with primary care providers can substantially increase rates of antidepressant treatment. Active follow-up by a depressio n nurse specialist in the QI-medications program was associated with longer -term increases in antidepressant use than in the QI model without such fol low-up.