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A primary care intervention for depression.

J L Smith1, K M Rost, P A Nutting

  • 1Center for Studies in Family Medicine, University of Colorado Health Sciences Center, 1180 Clermont Street, Box B155, Denver, Colorado 80220, USA. SmithJeffreyL@exchange.uams.edu

The Journal of Rural Health : Official Journal of the American Rural Health Association and the National Rural Health Care Association
|February 24, 2001
PubMed
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A guideline-based intervention significantly improved depression care in both rural and urban primary care settings. The positive effects on antidepressant use and mental health specialist visits were particularly pronounced in rural areas.

Area of Science:

  • Primary Care Research
  • Mental Health Services
  • Health Services Research

Background:

  • Depression care in primary care settings requires effective interventions.
  • Disparities in healthcare access and quality exist between rural and urban areas.
  • Guideline-based interventions aim to standardize and improve patient care.

Purpose of the Study:

  • To evaluate a guideline-based intervention for depression care.
  • To compare the intervention's effectiveness in rural versus urban primary care.
  • To assess impacts on antidepressant medication adherence and mental health specialist utilization.

Main Methods:

  • Randomized controlled trial involving 12 primary care practices (4 rural, 8 urban).
  • 479 depressed patients enrolled; 432 completed six-month follow-up.

Related Experiment Videos

  • Multilevel analytic models used to compare outcomes between enhanced and usual care groups.

    • Main Results:

    • Enhanced care significantly increased antidepressant medication adherence in both rural (OR=2.70) and urban (OR=2.43) settings.
    • Rural enhanced care patients showed significantly higher odds of utilizing mental health specialists (OR=3.00).
    • Intervention improved care for both rural and urban patients, with a greater impact observed in rural areas for specialist use.

    Conclusions:

    • A guideline-based intervention effectively enhances depression care in primary settings.
    • The intervention demonstrates particular promise for improving care in rural communities.
    • Future efforts should focus on optimizing mental health service access in underserved rural populations.