Managing depression as a chronic disease: a randomised trial of ongoing treatment in primary care

被引:133
作者
Rost, K
Nutting, P
Smith, JL
Elliott, CE
Dickinson, M
机构
[1] Univ Colorado, Hlth Sci Ctr, UCHSC Fitzsimmons,Ctr Studies Family Med, Dept Family Med, Aurora, CO 80045 USA
[2] Ctr Res Strategies, Denver, CO 80203 USA
来源
BMJ-BRITISH MEDICAL JOURNAL | 2002年 / 325卷 / 7370期
关键词
D O I
10.1136/bmj.325.7370.934
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives To evaluate the long term effect of ongoing intervention to improve treatment of depression in primary care. Design Randomised controlled trial. Setting Twelve primary care practices across the United States. Participants 211 adults beginning a new treatment episode for major depression; 94% of patients assigned to ongoing intervention participated. Intervention Practices assigned to ongoing intervention encouraged participating patients to engage in active treatment, using practice nurses to provide care management over 24 months. Main outcome measures Patients' report of remission and functioning. Results Ongoing intervention significantly improved both symptoms and functioning at 24 months, increasing remission by 33 percentage points (95% confidence interval 7% to 46%), improving emotional functioning by 24 points (11 to 38) and physical functioning by 17 points (6 to 28). By 24 months, 741% of patients in enhanced care reported remission, with emotional functioning exceeding 90% of population norms and physical functioning approaching 75% of population norms. Conclusions Ongoing intcrvention increased remission rates and improved indicators of emotional and physical functioning. Studies are needed to compare the cost effectiveness of ongoing depression management with other chronic disease treatment routinely undertaken by primary care.
引用
收藏
页码:934 / 937
页数:8
相关论文
共 50 条
[1]   Should depression be managed as a chronic disease? [J].
Andress, G .
BRITISH MEDICAL JOURNAL, 2001, 322 (7283) :419-421
[2]  
Angst J., 1988, Depression illness: prediction of course and outcome, P1
[3]   The long-term outcomes of mental health treatment in a population-based study [J].
Bovasso, GB ;
Eaton, WW ;
Armenian, HK .
JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY, 1999, 67 (04) :529-538
[4]  
Brown J B, 2000, Jt Comm J Qual Improv, V26, P39
[5]  
Bryk A.S., 1992, Hierarchical Models: Applications and Data Analysis Methods
[6]   IMPROVING TREATMENT OF LATE-LIFE DEPRESSION IN PRIMARY-CARE - A RANDOMIZED CLINICAL-TRIAL [J].
CALLAHAN, CM ;
HENDRIE, HC ;
DITTUS, RS ;
BRATER, DC ;
HUI, SL ;
TIERNEY, WM .
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 1994, 42 (08) :839-846
[7]  
Carr VJ, 1997, AUST NZ J PSYCHIAT, V31, P714
[8]  
Depression Guideline Panel, 1993, AHCPR PUBL, V2
[9]  
Fava M, 2001, J CLIN PSYCHIAT, V62, P4
[10]  
Goldberg H I, 1998, Jt Comm J Qual Improv, V24, P130