Evaluation of an Information Exchange Program for Primary Care Patients with Depression

Abstract

Background

A challenge in treating depression in the primary care setting is to improve its detection and maximize benefits associated with available therapies. This multicenter, prospective study was undertaken to evaluate the impact of an information exchange program on patients treated with fluoxetine for major depressive disorder (MDD) diagnosed and managed in the primary care setting.

Methods

The five-item Mental Health scale from the SF-36 Health Survey was used to screen for major depressive disorder (MDD). Patients with MDD based on Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSMIV) were randomly assigned at the physician level to an intervention group (fluoxetine therapy plus the ProPartnersTM [Hastings Health Care Group, Pennington, NJ] program) or a control group (fluoxetine therapy and usual care). Enrolled patients completed surveys at baseline, 3, 6, and 12 months. The surveys measured disease severity, health-related quality of life (QOL), and satisfaction with care.

Results

Of the 18,728 patients screened, 2,820 (15.1%) screened positively (Mental Health Inventory [MHI] score ≤ 52). Of those who screened positive, 68% met DSM IV criteria for MDD. Two hundred twelve patients met all eligibility criteria and were enrolled in the study (131 intervention, 81 control). Baseline QOL scores were significantly lower than U.S. population norms confirming the substantial QOL burden associated with MDD. Over a median follow-up period of 5.8 months, QOL in physical and mental health domains improved in both groups, confirming the known benefits of antidepressant therapy. The intervention patients exhibited better disease severity scores at end point than the control patients (p < 0.05) as measured by the Beck Depression Inventory.

Conclusion

A substantial number of patients seeking medical care in the primary care setting experience depression symptoms. Strategies that facilitate communication between patients with MDD and their primary care providers may improve recognition, treatment, and overall patient outcomes associated with MDD. This study provided useful information on the potential benefits of patient-oriented information exchange programs in the primary care setting.