Sustainable Impact of a Primary Care Depression Intervention

Sustainable Impact of a Primary Care Depression Intervention

Pamela W. Lee, PhD, Allen J. Dietrich, MD, Thomas E. Oxman, MD, John W. Williams, Jr, MD, MHSc and Sheila L. Barry, BA

Dartmouth Medical School, Hanover, NH (PWL, AJD, TEO, SLB)
Center for Health Services Research in Primary Care, Durham VAMC and Duke University Medical Center, Durham, NC (JWW)

Correspondence: Corresponding author: Pamela W. Lee, Dartmouth Medical School, 8925 Rubin Bldg., 8th Floor, One Medical Center Drive, Lebanon, NH (E-mail:
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Background: Re-Engineering Systems for Primary Care Treatment of Depression (RESPECT-D) sought to improve patient outcomes by disseminating the 3-component model of depression management. The purpose of this study was to determine whether an integrated model of depression management continued to be used by primary care clinicians after the end of a randomized controlled trial (RCT).

Methods: A descriptive evaluation was conducted at 2 time points. First, during a 12-month period after the end of the RESPECT-D RCT when referrals to care management were determined for each of the 5 participating health care organizations. Second, 3 years after the RCT ended, when clinicians were surveyed about use of the 3-component model.

Results: Three organizations continued to support the model with minimal modification. One made a major modification to it and one did not continue to support it. In the 12 months after the RCT, 1039 care management referrals were made. Seventy-one percent of RCT clinicians (n = 92) completed the follow-up survey. Of these, 87% reported using the Patient Health Questionnaire-9; 58.9% reported availability of care management and 45.1% reported availability of informal psychiatry consultation.

Conclusion: Practical clinical interventions can be sustained in primary care practice after the completion of an RCT. Additional resources may be needed to sustain and spread the program.

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