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Shared Decision Making for Antidepressants in Primary Care: A Cluster Randomized Trial.
Annie LeBlanc1, Jeph Herrin2, Mark D Williams3
1Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota2Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota3Robert D. and Patricia E. Kern Mayo Clinic Center for the Scie.
JAMA Internal Medicine
|September 29, 2015
Summary
The Depression Medication Choice (DMC) decision aid improved shared decision-making for antidepressants in patients with depression. However, it did not impact medication adherence or depression outcomes.
Area of Science:
- Clinical Medicine
- Health Services Research
- Psychiatry
Background:
- Translating evidence of comparative effectiveness for antidepressants into practice is suboptimal, impacting patient outcomes and quality of care.
- A novel decision aid, Depression Medication Choice (DMC), was developed to facilitate informed antidepressant selection by patients and clinicians.
- The study addresses the need for improved patient-centered care in depression treatment.
Purpose of the Study:
- To estimate the effect of the Depression Medication Choice (DMC) decision aid on the quality of the decision-making process and depression outcomes.
- To evaluate how DMC influences patient knowledge, involvement, and decisional comfort.
- To assess the impact of DMC on clinician decisional comfort and satisfaction.
Main Methods:
- A cluster randomized trial involving 117 clinicians and 301 adults with moderate to severe depression across 10 primary care practices.
- Practices were randomly allocated to receive usual care (UC) or usual care with the DMC decision aid.
- Outcomes included decision-making quality (knowledge, involvement, decisional comfort, satisfaction), encounter duration, medication adherence, and depression symptoms (PHQ-9).
Main Results:
- The DMC decision aid significantly improved patients' decisional comfort (80% vs 75%), knowledge (65% vs 56%), satisfaction, and involvement (47% vs 33%) compared to usual care.
- Clinicians also reported improved decisional comfort (80% vs 68%) and satisfaction with DMC use.
- No significant differences were observed in encounter duration, medication adherence, or depression symptom improvement between the DMC and UC groups.
Conclusions:
- The DMC decision aid enhances shared decision-making between primary care clinicians and patients for antidepressant selection in moderate to severe depression.
- While improving the decision-making process and patient-centeredness, DMC did not affect medication adherence or depression outcomes.
- DMC represents a successful translation of comparative effectiveness evidence into improved quality of primary care for depression.
