Among patients treated for depression in primary care, few receive recommended intensity of treatment. Delivery of appropriate acute-phase treatment to depressed primary care patients would significantly improve clinical outcomes. Our previous research, however, suggests that inadequate treatment is more a consequence of inadequate practice organization and follow-up than deficits in provider knowledge. Effective quality improvement must assure appropriate follow-up care and improve treatment adherence. Key ingredients of a systematic practice improvement program include: """"""""real time"""""""" monitoring of care processes, systematic assessment of outcomes, continuous feedback to providers, and support for outreach to patients who discontinue treatment prematurely. This proposal describes a randomized evaluation of such a population-based quality improvement program for depressed primary care patients. We will enroll approximately 45 primary care practices at Group Health Cooperative (a staff-model HMO) and randomize practices to 3 groups. In the """"""""usual care"""""""" group, physicians and patients will receive no specific intervention services. In the """"""""process feedback only group"""""""", physicians will receive reports on the progress of patients currently receiving acute-phase antidepressant treatment (medication adherence, follow-up visit frequency, specialty mental health treatment, recommendations for changes in treatment). In the """"""""process/outcome feedback plus practice support"""""""" physicians will receive the above reports as well as data on clinical response to treatment. Physicians in this group will also be supported by a """"""""population manager"""""""" who will assist in contacting patients to assure appropriate follow-up. A sample of patients treated by participating physicians (approximately 250 per group) will be contacted for independent, blinded assessment of clinical and functional outcomes 3 and 6 months after initiating treatment. HMO data systems will be used to assess medication use, follow-up visit frequency, and costs of care. Each of the intervention groups will be compared to the usual care group in terms of quality of care, clinical outcomes, functional outcomes, and treatment costs.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH051338-06
Application #
2890574
Study Section
Services Research Review Committee (SER)
Program Officer
Goldstein, Harold
Project Start
1994-06-01
Project End
2000-05-31
Budget Start
1999-06-18
Budget End
2000-05-31
Support Year
6
Fiscal Year
1999
Total Cost
Indirect Cost
Name
Center for Health Studies
Department
Type
DUNS #
078198520
City
Seattle
State
WA
Country
United States
Zip Code
98101
Simon, Gregory E; Ludman, Evette J (2013) Should mental health interventions be locally grown or factory-farmed? Am J Psychiatry 170:362-5
Tutty, Steve; Spangler, Diane L; Poppleton, Landon E et al. (2010) Evaluating the effectiveness of cognitive-behavioral teletherapy in depressed adults. Behav Ther 41:229-36
Simon, Gregory E; Ludman, Evette J; Rutter, Carolyn M (2009) Incremental benefit and cost of telephone care management and telephone psychotherapy for depression in primary care. Arch Gen Psychiatry 66:1081-9
Ludman, Evette J; Simon, Gregory E; Tutty, Steve et al. (2007) A randomized trial of telephone psychotherapy and pharmacotherapy for depression: continuation and durability of effects. J Consult Clin Psychol 75:257-66
Simon, Gregory E; Ludman, Evette J; Operskalski, Belinda H (2006) Randomized trial of a telephone care management program for outpatients starting antidepressant treatment. Psychiatr Serv 57:1441-5
Simon, Gregory E; Savarino, James; Operskalski, Belinda et al. (2006) Suicide risk during antidepressant treatment. Am J Psychiatry 163:41-7
Simon, Gregory E; Ludman, Evette J (2006) Outcome of new benzodiazepine prescriptions to older adults in primary care. Gen Hosp Psychiatry 28:374-8
Simon, Gregory E; Khandker, Rezaul K; Ichikawa, Laura et al. (2006) Recovery from depression predicts lower health services costs. J Clin Psychiatry 67:1226-31
Simon, Gregory E; Von Korff, Michael (2006) Medical co-morbidity and validity of DSM-IV depression criteria. Psychol Med 36:27-36
Tutty, Steve; Ludman, Evette Joy; Simon, Greg (2005) Feasibility and acceptability of a telephone psychotherapy program for depressed adults treated in primary care. Gen Hosp Psychiatry 27:400-10

Showing the most recent 10 out of 38 publications