Authors: Wells, Kenneth B.; Tang, Lingqi¹; Miranda, Jeanne; Benjamin, Bernadette²; Duan, Naihua³; Sherbourne, Cathy D.²

Source: Health Services Research, Volume 43, Number 6, December 2008 , pp. 1952-1974(23)

Publisher: Wiley-Blackwell

Abstract:

Objective.

To examine 9-year outcomes of implementation of short-term quality improvement (QI) programs for depression in primary care. Data Sources.

Depressed primary care patients from six U.S. health care organizations. Study Design.

Group-level, randomized controlled trial. Data Collection.

Patients were randomly assigned to short-term QI programs supporting education and resources for medication management (QI-Meds) or access to evidence-based psychotherapy (QI-Therapy); and usual care (UC). Of 1,088 eligible patients, 805 (74 percent) completed 9-year follow-up; results were extrapolated to 1,269 initially enrolled and living. Outcomes were psychological well-being (Mental Health Inventory, five-item version [MHI5]), unmet need, services use, and intermediate outcomes. Principal Findings.

At 9 years, there were no overall intervention status effects on MHI5 or unmet need (largest F (2,41)=2.34, p=.11), but relative to UC, QI-Meds worsened MHI5, reduced effectiveness of coping and among whites lowered tangible social support (smallest t(42)=2.02, p=.05). The interventions reduced outpatient visits and increased perceived barriers to care among whites, but reduced attitudinal barriers due to racial discrimination and other factors among minorities (smallest F (2,41)=3.89, p=.03). Conclusions.

Main intervention effects were over but the results suggest some unintended negative consequences at 9 years particularly for the medication-resource intervention and shifts to greater perceived barriers among whites yet reduced attitudinal barriers among minorities.

Keywords: Depression; quality improvement; long-term outcomes

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1475-6773.2008.00871.x

Affiliations: 1: Semel Institute for Neuroscience and Human Health, 760 Westwood Plaza, Los Angeles, CA 90095, 2: The RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, 3: Departments of Psychiatry and Biostatistics, Columbia University and the Division of Biostatistics, New York State Psychiatric Institute, New York, NY

Publication date: 2008-12-01

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