Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via HighWire Citing Articles via Google Scholar Articles by Fortney, J. Articles by Pyne, J. Search for Related Content PubMed Citation Articles by Fortney, J. Articles by Pyne, J. Outcome and Process Assessment Quality of Care, Practice Guidelines Depression

The Relationship Between Quality and Outcomes in Routine Depression Care

OBJECTIVE: This longitudinal, nonexperimental study examined whether depression treatment provided in concordance with guidelines developed by the Agency for Healthcare Research and Quality (AHRQ) is associated with improved clinical outcomes. METHODS: The medical, insurance, and pharmacy records of a community-based sample of 435 subjects who screened positive for current major depression were abstracted to ascertain whether depression treatment was received and whether it was provided in accordance with AHRQ guidelines. Regression analyses estimated the impact of guideline-concordant treatment on the change in depression severity and on mental and physical health over a six-month period. An instrumental variables analysis was used to check the sensitivity of the results to selection bias. RESULTS: A total of 106 subjects were treated for depression by 105 different primary care and specialty providers. Sixty percent of the sample had current major depression, and about 40 percent had subthreshold depression. Only 29 percent of the patients received guideline-concordant treatment. For patients with major depression, guideline-concordant care was significantly and substantially associated with improved depression severity but not with improvements in overall mental or physical health. The instrumental variables analysis indicated that the standard regression analysis underestimated the treatment effect by 21 percent. For those with subthreshold depression, guideline-concordant care was not associated with improved outcomes. Discussion and conclusions: This community-based, nonexperimental study found a positive relationship between the quality of care for depression and clinical outcomes for patients with major depression in routine practice settings.

This article has been cited by other articles:

				F. SCHNEIDER, M. HARTER, S. BRAND, P. SITTA, R. MENKE, U. HAMMER-FILIPIAK, R. KUDLING, A. HEINDL, K. HEROLD, U. FROMMBERGER, et al. Adherence to guidelines for treatment of depression in in-patients The British Journal of Psychiatry, November 1, 2005; 187(5): 462 - 469. [Abstract] [Full Text] [PDF]

				M. W. Smith and G. J. Joseph Pharmacy Data in the VA Health Care System Med Care Res Rev, September 1, 2003; 60(3_suppl): 92S - 123S. [Abstract] [PDF]

				H Tiemeier, W J de Vries, M van het Loo, J P Kahan, N Klazinga, R Grol, and H Rigter Guideline adherence rates and interprofessional variation in a vignette study of depression Qual. Saf. Health Care, September 1, 2002; 11(3): 214 - 218. [Abstract] [Full Text] [PDF]

Get information about faster international access.

Privacy Policy

Copyright © 2001 American Psychiatric Association. All rights reserved.

Home | Search | Current Issue | Past Issues | Subscribe | All APPI Journals | Help | Contact Us