Long-term effectiveness of disseminating quality improvement for depression in primary care

Background: This article addresses whether dissemination of short-term qual ity improvement (QI) interventions for depression to primary care practices improves patients' clinical outcomes and health-related quality of life (H RQOL) over 2 years, relative to usual care (UC). Methods: The sample included 1299 patients with current depressive symptoms and 12-month, lifetime, or no depressive disorder from 46 primary care pra ctices in 6 managed care organizations. Clinics were randomized to UC or 1 of 2 QI programs that included training local experts and nurse specialists to provide clinician and patient education, assessment, and treatment plan ning, plus either nurse care managers for medication follow-up (QI-meds) or access to trained psychotherapists (QI-therapy). Outcomes were assessed ev ery 6 months for 2 years. Results: For most outcomes, differences between intervention and UC patient s were not sustained for the full 2 years. However, QI-therapy reduced over all poor outcomes compared with UC by about 8 percentage points throughout 2 years, and by 10 percentage points compared with QI-meds at 24 months. Bo th interventions improved patients' clinical and role outcomes, relative to UC, over 12 months (eg, a 10-11 and 6-7 percentage point difference in pro bable depression at 6 and 12 months, respectively). Conclusions; While most outcome improvements were not sustained over the fu ll 2 study years, findings suggest that flexible dissemination of short-ter m, QI programs in managed primary care can improve patient outcomes well af ter program termination. Models that support integrated psychotherapy and m edication based treatment strategies in primary care have the potential for relatively long-term patient benefits.