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Clinical Trial
. 2004 Jul-Aug;2(4):301-4.
doi: 10.1370/afm.102.

Going to scale: re-engineering systems for primary care treatment of depression

Allen J Dietrich  1 , Thomas E Oxman, John W Williams Jr, Kurt Kroenke, H Charles Schulberg, Martha Bruce, Sheila L Barry
Affiliations
Clinical Trial

Going to scale: re-engineering systems for primary care treatment of depression

Allen J Dietrich et al. Ann Fam Med. 2004 Jul-Aug.

Abstract

Background: Recent trials have shown improved depression outcomes with chronic care models. We report the methods of a project that assesses the sustainability and transportability of a chronic care model for depression and change strategy.

Methods: In a randomized controlled trial (RCT), a clinical model for depression was implemented through a strategy supporting practice change. The clinical model is evidence based. The change strategy relies on established quality improvement programs and is informed by diffusion of innovations theory. Evaluation will address patient outcomes, as well as process of care and process of change.

Results: Five medical groups and health plans are participating in the trial. The RCT involves 180 clinicians in 60 practices. All practices assigned to the clinical model have implemented it. Participating organizations have the potential to disseminate this clinical model of care to 700 practices and 1,700 clinicians.

Conclusions: It is feasible to implement the clinical model and change strategy in diverse practices. Follow-up evaluation will determine the impact, sustainability, and potential for dissemination. Materials are available through http://www. depression-primarycare.org; more in-depth descriptions of the clinical model and change strategy are available in the online-only appendixes to this article.

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Figures

Figure 1.
Figure 1.
The Three Component Model. * Primary Care Clinician (PCC) follow up visits typically at 2, 6, and 12 weeks and as needed; PHQ-9 = Patient Health Questionnaire † After each patient contact, Care Manager sends report to PCC and discusses in psychiuatry supervision call. ‡ Discussed with psychiatrist or referral to specialty care.
Figure 2.
Figure 2.
The process of change strategy.
See this image and copyright information in PMC

References

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