Re-engineering systems for the treatment of depression in primary care: Cluster randomised controlled trial

Allen J. Dietrich, Thomas E. Oxman, John W. Williams, Herbert C. Schulberg, Martha L. Bruce, Pamela W. Lee, Sheila Barry, Patrick J. Raue, Jean J. Lefever, Moonseong Heo, Kathryn Rost, Kurt Kroenke, Martha Gerrity, Paul A. Nutting

Research output: Contribution to journalArticlepeer-review

250 Scopus citations


Objective: To test the effectiveness of an evidence based model for management of depression in primary care with support from quality improvement resources. Design: Cluster randomised controlled trial. Setting: Five healthcare organisations in the United States and 60 affiliated practices. Patients: 405 patients, aged ≥ 18 years, starting or changing treatment for depression. Intervention: Care provided by clinicians, with staff providing telephone support under supervision from a psychiatrist. Main outcome measures: Severity of depression at three and six months (Hopkins symptom checklist-20): response to treatment (≥ 50% decrease in scores) and remission (score of < 0.5). Results: At six months, 60% (106 of 177) of patients in intervention practices had responded to treatment compared with 47% (68 of 146) of patients in usual care practices (P = 0.02). At six months, 37% of intervention patients showed remission compared with 27% for usual care patients (P = 0.014). 90% of intervention patients rated their depression care as good or excellent at six months compared with 75% of usual care patients (P = 0.0003). Conclusion: Resources such as quality improvement programmes can be used effectively in primary care to implement evidence based management of depression and improve outcomes for patients with depression.

Original languageEnglish (US)
Pages (from-to)602-605
Number of pages4
JournalBritish Medical Journal
Issue number7466
StatePublished - Sep 11 2004
Externally publishedYes

ASJC Scopus subject areas

  • Medicine(all)


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