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Clinical Trial
. 2008 May;23(5):551-60.
doi: 10.1007/s11606-008-0522-3. Epub 2008 Feb 5.

Primary versus specialty care outcomes for depressed outpatients managed with measurement-based care: results from STAR*D

Bradley N Gaynes  1 , A John Rush, Madhukar H Trivedi, Stephen R Wisniewski, G K Balasubramani, Patrick J McGrath, Michael E Thase, Michael Klinkman, Andrew A Nierenberg, William R Yates, Maurizio Fava
Affiliations
Clinical Trial

Primary versus specialty care outcomes for depressed outpatients managed with measurement-based care: results from STAR*D

Bradley N Gaynes et al. J Gen Intern Med. 2008 May.

Abstract

Background: Whether the acute outcomes of major depressive disorder (MDD) treated in primary (PC) or specialty care (SC) settings are different is unknown.

Objective: To compare the treatment and outcomes for depressed outpatients treated in primary versus specialty settings with citalopram in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study (www.star-d.org), a broadly inclusive effectiveness trial.

Design: Open clinical trial with citalopram for up to 14 weeks at 18 primary and 23 specialty sites. Participants received measurement-based care with 5 recommended treatment visits, manualized pharmacotherapy, ongoing support and guidance by a clinical research coordinator, the use of structured evaluation of depressive symptoms and side effects at each visit, and a centralized treatment monitoring and feedback system.

Participants: A total of 2,876 previously established outpatients in primary (n = 1091) or specialty (n = 1785) with nonpsychotic depression who had at least 1 post-baseline measure.

Measurements and main results: Remission (Hamilton Depression Rating Scale for Depression [Hamilton] or 16-item Quick Inventory of Depressive Symptomatology-Self-Rated [QIDS-SR(16)]); response (QIDS-SR(16)); time to first remission (QIDS-SR(16)). Remission rates by Hamilton (26.6% PC vs 28.0% SC, p = .40) and by QIDS-SR(16) (32.5% PC vs 33.1% SC, p = .78) and response rates by QIDS-SR(16) (45.7% PC vs 47.6% SC, p = .33) were not different. For those who reached remission or response at exit, the time to remission (6.2 weeks PC vs 6.9 weeks SC, p = .12) and to response (5.5 weeks PC vs 5.4 weeks SC, p = .97) did not differ by setting.

Conclusions: Identical remission and response rates can be achieved in primary and specialty settings when identical care is provided.

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Figures

Figuer 1
Figuer 1
Consort Chart Hamilton: 17-item Hamilton Rating Scale for Depression.
Figure 2
Figure 2
Time to Remission (QIDS-SR16) by Clinical Setting. QIDS-SR16 16-item Quick Inventory of Depressive Symptomatology-Self-Rated.
Figure 3
Figure 3
Odds of remission in specialty care (vs Primary Care) as a function of baseline depressive severity. QIDS-SR16 16-item Quick Inventory of Depressive Symptomatology-Self-rated. Odds ratios of <1 indicate a greater chance of remission in PC settings. Ratios >1 indicate a greater chance of remission in SC settings.
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