Major Depressive Disorder
Conditions
Keywords
Depression, Primary Care, Care Manager
Brief summary
This project will enable the investigators to conduct a randomized clinical trial to demonstrate the value of generalist care managers in the treatment of depression in Medicaid patients seen in primary health care practices. Depressed patients will be recruited at two primary care practices in Western North Carolina and randomly assigned to either generalist care management or usual care. Patients in each condition will be assessed at baseline and six months follow-up. Outcomes will include depressive symptoms, level of functioning, and cost-effectiveness measures.
Detailed description
Randomized trial among depressed Medicaid patients aged 18 years and older in 2 primary care practices in Western NC comparing an intervention with a GCM to usual care (UC) between July 2003 and February 2005. GCMs, already providing diabetes and asthma services, were further trained and given ongoing supervision to provide algorithm-based depression care to enhance guideline concordant treatment. GCMs provided elements of self-management, decision support, use of information systems, and core care management components.
Interventions
PROCEDUREGeneralist Care Manager vs Usual Care
Sponsors
Robert Wood Johnson Foundation
University of North Carolina
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* scoring 10 or greater on PHQ-9 and primary care physician verification of major depression by clinical exam; and * willing to begin or continue antidepressant medication
Exclusion criteria
* bipolar disorder, psychotic symptoms, or active suicidal ideation requiring psychiatric admission (
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Baseline, 3 and 6-month Patient Health Questionnaire (PHQ9) scores | — |
Secondary
| Measure | Time frame |
|---|---|
| Baseline and 6-month Short Form (SF)-12 scores, Medicaid claims data; patient perception of treatment by self-report; review of GCM case notes, physician and office staff time study; physician and office staff focus groups | — |
Countries
United States
Outcome results
None listed