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Improving depression management in primary care

 

Clinical bottom line

Strategies effective in improving patient outcome generally were those with complex interventions incorporating clinician education, and enhanced role for the nurse, and a greater degree of integration between primary and secondary care.

Simple guideline implementation and educational strategies were generally ineffective.

Reference


S Gilbody et al. Educational and organizational interventions to improve the management of depression in primary care: a systematic review. JAMA 2003 289: 3145-3151.


Systematic review

At least eight electronic databases and specialist registers were searched, and authors and others contacted to find randomised, controlled, before-after, and other architectures of study examining depression management in primary care. Outcomes of interest were the management and outcomes of depression, quality of life and costs.

Results

There were 36 included studies, 29 of which were randomised controlled trials, five controlled trials without randomisation (before-after), and two interrupted time series studies. Most were conducted in the USA. Types of intervention were:

Because of the heterogeneous nature of the studies, no data synthesis was possible.

Strategies effective in improving patient outcome generally were those with complex interventions incorporating clinician education, and enhanced role for the nurse, and a greater degree of integration between primary and secondary care. Telephone mediation by practice nurses or counsellors was also effective.

Simple guideline implementation and educational strategies were generally ineffective.

Comment

This is a cracking paper for which no précis will ever do justice. Those professionals interested in depression management need to read this paper very carefully.