A randomized trial using computerized decision support to improve treatment of major depression in primary care
Journal of General Internal MedicinePublished 1 July 2002Open access
Bruce L. Rollman, Barbara H. Hanusa, Henry Lowe, Trae Gilbert, Wishwa N. Kapoor, Herbert C. Schulberg
Citations132
SJR quartileQ1
SJR score1.99
SNIP1.71
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Screening for major depression, electronically informing PCPs of the diagnosis, and then exposing them to evidence-based treatment recommendations for depression via EMR has little differential impact on patients’ 3- or 6-month clinical outcomes or on process measures consistent with high-quality depression care.
Abstract
Screening for major depression, electronically informing PCPs of the diagnosis, and then exposing them to evidence-based treatment recommendations for depression via EMR has little differential impact on patients' 3- or 6-month clinical outcomes or on process measures consistent with high-quality depression care.
Keywords
PsychologyMedicine
Medical CareA 12-Item Short-Form Health Survey
17,142 Citations1996John E. Ware, Mark Kosinski +1 more
Twenty cross-sectional and longitudinal tests of empirical validity previously published for the 36-item short-form scales and summary measures were replicated for the 12-item Physical Component Summary and the12-item Mental Component Summary, including comparisons between patient groups known to differ or to change in terms of the presence and seriousness of physical and mental conditions.
JAMAValidation and Utility of a Self-report Version of PRIME-MD<SUBTITLE>The PHQ Primary Care Study</SUBTITLE>
9,822 Citations1999Robert L. Spitzer
The study suggests that the PHQ has diagnostic validity comparable to the original clinician-administered PRIME-MD, and is more efficient to use.
JAMADetecting Alcoholism
2,957 Citations1984John A. Ewing
Four clinical interview questions, the CAGE questions, have proved useful in helping to make a diagnosis of alcoholism and their use in clinical and research studies is described.
Milbank QuarterlyOrganizing Care for Patients with Chronic Illness
2,900 Citations1996Edward H. Wagner, Brian T. Austin +1 more
The challenge is to organize these components into an integrated system of chronic illness care, which can be done most efficiently and effectively in primary care practice rather than requiring specialized systems of care.
JAMAThe functioning and well-being of depressed patients. Results from the Medical Outcomes Study
2,524 Citations1989Kenneth B. Wells
JAMAUtility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study
2,324 Citations1994Robert L. Spitzer
JAMAThe Functioning and Well-being of Depressed Patients
2,119 Citations1989Kenneth B. Wells
Depressed patients tended to have worse physical, social, and role functioning, worse perceived current health, and greater bodily pain than did patients with no chronic conditions.
JAMAUtility of a New Procedure for Diagnosing Mental Disorders in Primary Care
1,861 Citations1994Robert L. Spitzer
Primary Care Evaluation of Mental Disorders appears to be a useful tool for identifying mental disorders in primary care practice and research.
PubMedEffects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review.
1,690 Citations1998Dereck L. Hunt, R. Brian Haynes +2 more
The CDSSs can enhance clinical performance for drug dosing, preventive care, and other aspects of medical care, but not convincingly for diagnosis.
JAMACollaborative Management to Achieve Treatment Guidelines
1,395 Citations1995Wayne Katon
A multifaceted intervention consisting of collaborative management by the primary care physician and a consulting psychiatrist, intensive patient education, and surveillance of continued refills of antidepressant medication improved adherence to antidepressant regimens in patients with major and with minor depression and resulted in more favorable depressive outcomes.
JAMADepression, Disability Days, and Days Lost From Work in a Prospective Epidemiologic Survey
1,208 Citations1990W E Broadhead
The threshold for identifying clinically significant depression may need to be reevaluated to include persons with fewer symptoms but measurable morbidity, only by changing the nosology can the societal impact of depression be adequately addressed.
JAMAImpact of Disseminating Quality Improvement Programs for Depression in Managed Primary Care
1,033 Citations2000Kenneth B. Wells, Cathy Sherbourne +7 more
When managed primary care practices implemented QI programs that improve opportunities for depression treatment without mandating it, quality of care, mental health outcomes, and retention of employment of depressed patients improved over a year, while medical visits did not increase overall.
PubMedUtility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study.
1,027 Citations1994Robert Spitzer, Janet B. W. Williams +6 more
Archives of General PsychiatryFunctioning and Well-being Outcomes of Patients With Depression Compared With Chronic General Medical Illnesses
848 Citations1995Ron D. Hays
Depressed patients have substantial and long-lasting decrements in multiple domains of functioning and well-being that equal or exceed those of patients with chronic medical illnesses.
PubMedThe functioning and well-being of depressed patients. Results from the Medical Outcomes Study.
845 Citations1989Kenneth B. Wells, Anita L. Stewart +7 more
New England Journal of MedicineProtocol-Based Computer Reminders, the Quality of Care and the Non-Perfectability of Man
811 Citations1976Clement J. McDonald
It appears that the prospective reminders do reduce errors, and that many of these errors are probably due to man's limitations as a data processor rather than to correctable human deficiencies.
American Journal of EpidemiologyRANDOMIZATION BY CLUSTER
696 Citations1981Allan Donner, Nicholas Birkett +1 more
General Hospital PsychiatryEpidemiology of depression in primary care
676 Citations1992Wayne Katon, Herbert C. Schulberg
The majority of longitudinal studies have determined that severity of initial depressive symptoms and the presence of a comorbid medical illness were predictors of persistence of depression.
Annals of Internal MedicineImplementing Antibiotic Practice Guidelines through Computer-Assisted Decision Support: Clinical and Financial Outcomes
590 Citations1996Stanley L. Pestotnik, David C. Classen +2 more
For more than a decade, LDS Hospital has been developing and investigating clinical management programs that augment and inform clinical decision making, in addition to focusing on continual quality improvement in antibiotic therapy, infection control surveillance, and the safety of drug use.
Medical CareThe Role of the Primary Care Physician in Patientsʼ Adherence to Antidepressant Therapy
588 Citations1995Elizabeth Lin, Michael Von Korff +5 more
Primary care physicians may be able to enhance adherence to antidepressant therapy by simple and specific educational messages easily integrated into primary care visits.
New England Journal of MedicineA Computerized Reminder System to Increase the Use of Preventive Care for Hospitalized Patients
529 Citations2001Paul Dexter, Susan M. Perkins +4 more
A majority of hospitalized patients in this study were eligible for preventive measures, and computerized reminders significantly increased the rate of delivery of such therapies.
BMJRandomised trial of monitoring, feedback, and management of care by telephone to improve treatment of depression in primary care
523 Citations2000Gwendal Simon
A programme of systematic follow up and care management by telephone, however, significantly improved outcomes at modest cost.
Archives of Family MedicineRecognition, management, and outcomes of depression in primary care
522 Citations1995Gregory E. Simon
While many depressed primary care patients may go unrecognized and untreated, this group appears to have milder and more self-limited depression.
Archives of General PsychiatryTreating Major Depression in Primary Care Practice
463 Citations1998Herbert C. Schulberg, Wayne Katon +2 more
Evidence indicates that both antidepressant pharmacotherapy and time-limited depression-targeted psychotherapies are efficacious when transferred from psychiatric to primary care settings.
Archives of General PsychiatryTreating Major Depression in Primary Care Practice
433 Citations1996Herbert C. Schulberg
Severity of depressive symptoms was reduced more rapidly and more effectively among patients randomized to pharmacotherapy or psychotherapy than among patients assigned to a physician's usual care.
Archives of Internal MedicineImproving Preventive Care by Prompting Physicians
379 Citations2000E. Andrew Balas
Dependable performance improvement in preventive care can be accomplished through prompting physicians, and vigorous application of this simple and effective information intervention could save thousands of lives annually.
Archives of Internal MedicineDepression in Medical Outpatients
351 Citations1990Eliseo J. Pérez‐Stable
Receiver operating characteristic curves of two self-report depression scales suggest that these scales may assist physicians in recognizing depressed outpatients.
Archives of Family MedicineThe Role of Competing Demands in the Treatment Provided Primary Care Patients With Major Depression
275 Citations2000Kathryn Rost
The attention depression gets during a given medical visit is less associated with the severity of the patient's depressive symptoms than with the number or recency of other problems the patient has.
Archives of Family MedicineThe deliberate misdiagnosis of major depression in primary care
265 Citations1994Kathryn Rost
The practice of deliberately substituting another diagnostic code for major depression is widespread among primary care providers and the impact of substitution on the health care system as a whole deserves more careful consideration.
Journal of General Internal MedicineRequiring physicians to respond to computerized reminders improves their compliance with preventive care protocols
235 Citations1993Debra K. Litzelman, Robert S. Dittus +2 more
Requiring physicians to respond to computer-generated reminders improved their compliance with preventive care protocols, especially for elderly patients for whom control physicians’ compliance was the lowest.
JAMAA Computer-Administered Telephone Interview to Identify Mental Disorders
232 Citations1997Kenneth A. Kobak
The computer-administered PRIME-MD appears to be a valid instrument for assessing psychopathology in primary care patients and allows for increased availability, and provides primary care physicians with information that will increase the quality of patient care without additional physician time and at minimal expense.
Journal of the American Medical Informatics AssociationComputerizing Guidelines to Improve Care and Patient Outcomes: The Example of Heart Failure
215 Citations1995William M. Tierney, J. Marc Overhage +5 more
Attempts to incorporate complex guidelines for heart failure into a network of physicians' interactive microcomputer workstations are reported, finding that the task proved difficult because the guidelines often lack explicit definitions that are necessary to navigate the AHCPR algorithm.
Annals of Internal MedicineEffectiveness of Computer-Generated Reminders for Increasing Discussions about Advance Directives and Completion of Advance Directive Forms
195 Citations1998Paul Dexter, Fredric D. Wolinsky +5 more
This study tested the hypothesis that reminding primary care physicians to discuss advance directives would stimulate such discussions and lead to the establishment of more advance directives, and showed that computer reminders increase physician compliance with practice guidelines.
Medical CareImproving Physicians?? Recognition and Treatment of Depression in General Medical Care
165 Citations1990Kathryn Magruder-Habib, William W.K. Zung +1 more
Routine use of a depression screening instrument can improve physician recognition of depression, with increased initiation of treatment, according to patients with high somatic or low psychologic symptoms of depression.
PubMedEffects of computer reminders for influenza vaccination on morbidity during influenza epidemics.
161 Citations1992Clement J. McDonald, Siu L. Hui +1 more
The physicians who received the reminders vaccinated eligible patients twice as often as did the control physicians, and the greater use of influenza vaccine in the intervention group was the most likely explanation for the difference.
PubMedDepression and chronic medical illness.
160 Citations1990W Katon, Mark D. Sullivan
Double-blind, placebo-controlled studies have increasingly demonstrated efficacy of the antidepressant agents in primary care patients, patients with chronic pain, and patients with comorbidity--chronic medical illness and major depression.
Journal of Psychiatric ResearchA structured interview version of the Hamilton Depression Rating Scale: Evidence of reliability and versatility of administration
148 Citations1990Marilyn K. Potts, Marcia Daniels +2 more
A structured interview version of the Hamilton Depression Rating Scale (SI-HDRS) that does not require a face-to-face interview by an experienced clinician and can be used economically in large-scale, community-based research projects.
The LancetGuidelines for management of HIV infection with computer-based patient's record
145 Citations1995Charles Safran, David M. Rind +7 more
The electronic medical record was effective in helping clinicians adhere to practice guidelines in a nonrandomised, controlled, prospective trial of electronic messages to enhance adherence to clinical practice guidelines.
Medical CareA Computer-Based Monitoring System for Follow-Up of Elevated Blood Pressure
140 Citations1983G. Octo Barnett, Richard N. Winickoff +2 more
It is concluded that a computer-based reminder system improves follow-up of newly discovered elevation in diastolic blood pressure.
Archives of Family MedicineThe 'usual care' of major depression in primary care practice
135 Citations1997Herbert C. Schulberg
The recovery rates for the patients with major depression who were treated with usual care in routine primary care practices were lower than those anticipated from treatments consistent with the Agency for Health Care Policy and Research guidelines.
New England Journal of MedicinePolymyositis and Dermatomyositis
122 Citations1975W Rawlings, Justin W. Griffin +3 more
Medical CareAn Experiment to Change Detection and Management of Mental Morbidity in Primary Care
113 Citations1987Sam Shapiro, Pearl S. German +8 more
The study results showed that feedback of GHQ information led to only marginal effects on overall detection of mental health problems among the patients in general, however, marked increases in detection occurred among the elderly, blacks, and men, subgroups that ordinarily have relatively low rates of detection ofmental morbidity by primary care practitioners.
Journal of the American Medical Informatics AssociationA Comparison of the Effects of Computer and Manual Reminders on Compliance with a Mental Health Clinical Practice Guideline
100 Citations2000Dale S. Cannon, Steven N. Allen
In an outpatient mental health clinic, computer reminders were shown to be superior to manual reminders in improving adherence to a clinical practice guideline for depression.
Academic MedicineThe effect of screening, sensitization, and feedback on notation of depression
99 Citations1980Lawrence S. Linn, Joel Yager
Medical records of 150 medical ambulatory care patients randomly assigned to groups in which screening for depression, physician sensitization about depression, and informational feedback to physicians were systemically varied were reviewed for physician notations about depression and its treatment.
BMJRandomised controlled trial of computer assisted management of hypertension in primary care.
84 Citations1986N. H. McAlister, H. Dominic Covvey +3 more
The hypothesis that general practitioners would obtain better outcomes for patients with hypertension using a computer than doctors not using aComputer was tested and the length of follow up was significantly longer in test practices.
Archives of Internal MedicineThe Electronic Medical Record
78 Citations2001Bruce L. Rollman, Barbara H. Hanusa +4 more
Electronic feedback of the diagnosis of major depression can affect PCP initial management of the disorder and it is necessary to determine whether this strategy, combined with delivery of treatment recommendations, can improve clinical outcomes in routine practice.
PubMedThe effects of computerized medical records on provider efficiency and quality of care.
50 Citations1986Leland E. Garrett, W. Ed Hammond +1 more
Journal of General Internal MedicineIdentifying suicide potential in primary care
44 Citations1989Elizabeth Lin, Michael Von Korff +1 more
Medical records data for suicides and for symptomatically depressed and non-depressed enrollees of an HMO were compared and suicidal ideation and behavior, selected psychiatric diagnoses, and interpersonal problems were associated with suicide.
Methods of Information in MedicineThe Effects of Computerized Medical Records on Provider Efficiency and Quality of Care
38 Citations1986L. E. Garrett, W. Ed Hammond +1 more
The implementation of a comprehensive medical information system, TMR, in the renal clinic of the Durham VA Medical Center resulted in significant reductions in the time required for the physicians to obtain data from and enter data into the record, with the exception of prescription writing.
The International Journal of Psychiatry in MedicineThe Electronic Medical Record: Its Role in Disseminating Depression Guidelines in Primary Care Practice
23 Citations1999Bruce L. Rollman, Trae Gilbert +3 more
The EMR offers critical efficiencies in disseminating state-of-the-art clinical practice guidelines and in directing the primary care physicians' use of them, but well-designed, randomized controlled trials are necessary to demonstrate their effectiveness at enhancing patient outcomes for major depression in primary care settings.
Medical InformaticsImproving the Consistency with which Investigations are Requested
15 Citations1981David W. Young
A computer-based prompt system improved the frequency with which a set of routine laboratory investigations were ordered, and the number of tests not ordered fell in two studies.
PubMed CentralPatient-specific Computerized Outpatient Reminders to Improve Physician Compliance with Clinical Guidelines
5 Citations2000Andrew S. Karson, Gilad J. Kuperman +4 more
A multidisciplinary team created 16 specific reminders within 4 clinical categories based on data from the clinical information system and ambulatory electronic medical record, including patient age, gender, problem list, medication list, laboratory data, radiology reports, and visit details.