OBJECTIVE: To determine whether redefining primary care team roles would im
prove outcomes for patients beginning a new treatment episode for major dep
DESIGN: Following stratification, 6 of 12 practices were randomly assigned
to the intervention condition. Intervention effectiveness was evaluated by
patient reports of 6-month change in 100-point depression symptom and funct
ional status scales.
SETTING: Twelve community primary care practices across the country employi
ng no onsite mental health professional.
PATIENTS: Using two-stage screening, practices enrolled 479 depressed adult
patients (73.4% of those eligible); 90.2% completed six-month follow-up.
INTERVENTION: Two primary care physicians, one nurse, and one administrativ
e staff member in each intervention practice received brief training to imp
rove the detection and management of major depression.
MAIN RESULTS: In patients beginning a new treatment episode, the interventi
on improved depression symptoms by 8.2 points (95% confidence interval [CI]
, 0.2 to 16.1: P=.04), Within this group, the intervention improved depress
ion symptoms by 16.2 points (95% CI, 4.5 to 27.9; P =.007), physical role f
unctioning by 14.1 points (95% CI, 1.1 to 29.2; P =.07], and satisfaction w
ith care (P =.02) for patients who reported antidepressant medication was a
n acceptable treatment at baseline. Patients already in treatment at enroll
ment did not benefit from the intervention.
CONCLUSIONS: In practices without onsite mental health professionals, brief
interventions training primary care teams to assume redefined roles can si
gnificantly improve depression outcomes in patients beginning a new treatme
nt episode. Such interventions should target patients who report that antid
epressant medication is an acceptable treatment for their condition. More r
esearch is needed to determine how primary care teams can best sustain thes
e redefined roles over time.