Depression decision support in primary care: a cluster randomized trial.

Area of Science:

• Primary care research
• Mental health services research
• Clinical decision support systems

Background:

• Intensive collaborative interventions show promise for improving depression outcomes.
• The effectiveness of less intensive interventions, such as decision support, remains unclear.

Purpose of the Study:

• To evaluate the impact of a decision support system on depression outcomes among primary care patients.
• To assess secondary outcomes including quality-of-life, patient satisfaction, and healthcare utilization.

Main Methods:

• A clinician-level, cluster randomized controlled trial was conducted across 5 primary care clinics.
• 375 patients with moderate depression (PHQ-9 scores 10-25 or SCL-20 scores ≥1.0) were included.
• Clinicians received depression education; some were randomized to receive depression decision support from a dedicated team.

Main Results:

• No significant difference in depression symptom scores (SCL-20) was observed between the decision support and usual care groups at 6 or 12 months.
• Patients receiving decision support reported higher satisfaction and were more likely to receive antidepressant treatment and mental health specialty care.
• Health-related quality-of-life (SF-36V) scores did not differ between the groups.

Conclusions:

• Decision support interventions can improve care processes, such as patient satisfaction and treatment adherence.
• The current decision support model did not significantly improve depression outcomes, potentially due to concurrent high-quality usual care.
• More intensive care management or direct specialty mental health treatment may be necessary to achieve better depression outcomes.