Meeuwissen et al 2012 IJPCM (original) (raw)
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T he I nt e rna t iona l J ourna l of Pe rson Ce nt e re d M e dic ine V ol 2 I ssue 4 pp 7 1 6 -7 5 8 716 ARTICLE M e t a -a na lysis a nd m e t a -regre ssion ana lyses e x pla ining he t e roge ne it y in out com es of c hronic c a re m ana gem e nt for de pre ssion: im plic a t ions for pe rson-ce nt e red m e nt a l he a lt hc a re Abst ra c t Rationale, aims and objectives: Chronic care management programmes for depression show variation in effectiveness. This study aims to examine the clinical diversity and methodological heterogeneity related to the effectiveness of such programmes and to explain the heterogeneity in clinical outcomes. Objectives are to enable the understanding of and the decision-making about depression management programmes and to contribute to the implementation of chronic care management strategies for depression as part of advances in person-centered mental healthcare. Method: We performed a systematic review of reviews and empirical studies, including meta-analyses and meta-regression analyses on the most frequently reported outcomes. We explored to what extent the observed heterogeneity can be explained by study quality, length of follow-up, number of components of the Chronic Care Model (CCM) and patient characteristics. Results: Pooled effects of depression management programmes show significant improvement in treatment response (RR=1.38; p<0.05) and treatment adherence (RR=1.36; p<0.05). In meta-regression analysis, study quality and depression severity explain the substantial heterogeneity in respectively treatment response (36.6%; p=0.0352) and treatment adherence (88.7%; p=0.0083). Conclusions: The observed heterogeneity in depression outcomes cannot be explained by the number of intervention components and length of follow-up. Yet, the heterogeneity in treatment response can be explained partly by study quality, demonstrating the importance of good quality studies. Heterogeneity in treatment adherence can be explained partly by severity of the depression, indicating that taking account of depression severity contributes to maximising the effectiveness of chronic care management. Other potential sources of heterogeneity should be investigated to support informed decisionmaking on treating depression as a chronic condition as part of person-centered healthcare.
Systematic review of multifaceted interventions to improve depression care
General Hospital Psychiatry, 2007
Recent epidemiologic studies have found that most patients with mental illness are seen exclusively in primary care medicine. These patients often present with medically unexplained somatic symptoms and utilize at least twice as many health care visits as controls. There has been an exponential growth in studies in this interface between primary care and psychiatry in the last 10 years. This special section, edited by Jü rgen Unutzer, M.D., will publish informative research articles that address primary care-psychiatric issues.
Annals of family medicine
We performed a systematic review of the currently available evidence on whether psychological treatments are effective for treating depressed primary care patients in comparison with usual care or placebo, taking the type of therapy and its delivery mode into account. Randomized controlled trials comparing a psychological treatment with a usual care or a placebo control in adult, depressed, primary care patients were identified by searches in MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and PsycINFO up to December 2013. At least 2 reviewers extracted information from included studies and assessed the risk of bias. Random effects meta-analyses were performed using posttreatment depression scores as outcome. A total of 30 studies with 5,159 patients met the inclusion criteria. Compared with control, the effect (standardized mean difference) at completion of treatment was -0.30 (95% CI, -0.48 to -0.13) for face-to-face cognitive behavioral therapy (CBT), -...
Journal of Primary Care & Community Health, 2013
The information in this report is intended to help health care decisionmakers-patients and clinicians, health system leaders, and policymakers, among others-make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients. This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products or actions may not be stated or implied. This document is in the public domain and may be used and reprinted without special permission, except those copyrighted materials that are clearly noted in the document. Further reproduction of those copyrighted materials is prohibited without the specific permission of copyright holders.
Predictors of outcome in a primary care depression trial
Journal of General Internal Medicine, 2000
OBJECTIVE: Previous treatment trials have found that approximately one third of depressed patients have persistent symptoms. We examined whether depression severity, comorbid psychiatric illness, and personality factors might play a role in this lack of response. DESIGN: Randomized trial of a stepped collaborative care intervention versus usual care.
Journal of Personalized Medicine, 2022
While randomized trials typically lack sufficient statistical power to identify predictors and moderators of outcome, ”individual participant data” (IPD) meta-analyses, which combine primary data of multiple randomized trials, can increase the statistical power to identify predictors and moderators of outcome. We conducted a systematic review of IPD meta-analyses on psychological treatments of depression to provide an overview of predictors and moderators identified. We included 10 (eight pairwise and two network) IPD meta-analyses. Six meta-analyses showed that higher baseline depression severity was associated with better outcomes, and two found that older age was associated with better outcomes. Because power was high in most IPD meta-analyses, non-significant findings are also of interest because they indicate that these variables are probably not relevant as predictors and moderators. We did not find in any IPD meta-analysis that gender, education level, or relationship status ...
BMC Psychiatry, 2010
Background: People with chronic depression are frequently lost from effective care, with resulting psychological, physical and social morbidity and considerable social and financial societal costs. This randomised controlled trial will evaluate whether regular structured practice nurse reviews lead to better mental health and social outcomes for these patients and will assess the cost-effectiveness of the structured reviews compared to usual care. The hypothesis is that structured, pro-active care of patients with chronic depression in primary care will lead to a cost-effective improvement in medical and social outcomes when compared with usual general practitioner (GP) care.
Randomized Trial of a Depression Management Program in High Utilizers of Medical Care
Archives of Family Medicine, 2000
Background: High utilizers of nonpsychiatric health care services have disproportionally high rates of undiagnosed or undertreated depression. Objective: To determine the impact of offering a systematic primary care-based depression treatment program to depressed "high utilizers" not in active treatment. Design: Randomized clinical trial. Setting: One hundred sixty-three primary care practices in 3 health maintenance organizations located in different geographic regions of the United States. Patients: A group of 1465 health maintenance organization members were identified as depressed high utilizers using a 2-stage telephone screening process. Eligibility criteria were met by 410 patients and 407 agreed to enroll: 218 in the depression management program (DMP) practices and 189 in the usual care (UC) group. Intervention: The DMP included patient education materials,physicianeducationprograms,telephone-basedtreatment coordination, and antidepressant pharmacotherapy initiated and managed by patients' primary care physicians. Main Outcome Measures: Depression severity was measured using the Hamilton Depression Rating Scale (Ham-D) and functional status using the Medical Outcomes Study 20-item short form (SF-20) subscales. Outpatient visit and hospitalization rates were measured using the health plan's encounter data. Results: Based on an intent-to-treat analysis, at least 3 antidepressant prescriptions were filled in the first 6 months by 151 (69.3%) of 218 of DMP patients vs 35 (18.5%) of 189 in UC (PϽ.001). Improvements in Ham-D scores were significantly greater in the intervention group at 6 weeks (P = .04), 3 months (P = .02), 6 months (PϽ.001), and 12 months (PϽ.001). At 12 months, DMP intervention patients were more improved than UC patients on the mental health, social functioning, and general health perceptions scales of the SF-20 (PϽ.05 for all). Conclusion: In depressed high utilizers not already in active treatment, a systematic primary care-based treatment program can substantially increase adequate antidepressant treatment, decrease depression severity, and improve general health status compared with usual care.