Presented in part at the 13th National Institute of Mental Health International Conference on Mental Health Problems in the General Health Sector, Washington, D.C., July 12, 1999.
A Randomized Trial Using Computerized Decision Support to Improve Treatment of Major Depression in Primary Care
Article first published online: 24 JUL 2002
Journal of General Internal Medicine
Volume 17, Issue 7, pages 493–503, July 2002
How to Cite
Rollman, B. L., Hanusa, B. H., Lowe, H. J., Gilbert, T., Kapoor, W. N. and Schulberg, H. C. (2002), A Randomized Trial Using Computerized Decision Support to Improve Treatment of Major Depression in Primary Care. Journal of General Internal Medicine, 17: 493–503. doi: 10.1046/j.1525-1497.2002.10421.x
- Issue published online: 24 JUL 2002
- Article first published online: 24 JUL 2002
- major depression;
- primary care;
- electronic medical records;
- clinical practice guidelines;
OBJECTIVE: To examine whether feedback and treatment advice for depression presented to primary care physicians (PCPs) via an electronic medical record (EMR) system can potentially improve clinical outcomes and care processes for patients with major depression.
DESIGN: Randomized controlled trial.
SETTING: Academically affiliated primary care practice in Pittsburgh, PA.
PATIENTS: Two hundred primary care patients with major depression on the Primary Care Evaluation of Mental Disorders (PRIME-MD) and who met all protocol-eligibility criteria.
INTERVENTION: PCPs were randomly assigned to 1 of 3 levels of exposure to EMR feedback of guideline-based treatment advice for depression: “active care” (AC), “passive care” (PC), or “usual care” (UC).
MEASUREMENTS AND MAIN RESULTS: Patients' 3- and 6-month Hamilton Rating Scale for Depression (HRS-D) score and chart review of PCP reports of depression care in the 6 months following the depression diagnosis. Only 22% of patients recovered from their depressive episode at 6 months (HRS-D ≤7). Patients' mean HRS-D score decreased regardless of their PCPs' guideline-exposure condition (20.4 to 14.2 from baseline to 6-month follow-up; P < .001). However, neither continuous (HRS-D ≤7: 22% AC, 23% PC, 22% UC; P = .8) nor categorical measures of recovery (P = .2) differed by EMR exposure condition upon follow-up. Care processes for depression were also similar by PCP assignment despite exposure to repeated reminders of the depression diagnosis and treatment advice (e.g., depression mentioned in ≥3 contacts with usual PCP at 6 months: 31% AC, 31% PC, 18% UC; P = .09 and antidepressant medication suggested/prescribed or baseline regimen modified at 6 months: 59% AC, 57% PC, 52% UC; P = .3).
CONCLUSIONS: Screening for major depression, electronically informing PCPs of the diagnosis, and then exposing them to evidence-based treatment recommendations for depression via EMR has little differential impact on patients' 3- or 6-month clinical outcomes or on process measures consistent with high-quality depression care.