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A depression management programme reduced depression in frequent users of health care but did not reduce healthcare visits

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 QUESTION: Does a programme to identify and treat depression in frequent users of medical care improve clinical outcomes and reduce total healthcare use?


Cluster randomised {allocation concealed*}, blinded (telephone assessment),* controlled trial with 1 year follow up.


Primary care clinics of 3 health management organisations (HMOs) in the US (Wisconsin, Washington, and Massachusetts).


407 patients who were 25–63 years of age (mean age 45 y, 77% women), had continuous health plan enrolment for ≥ 2 years, were frequent healthcare users (ambulatory visits per year above the 85th centile for previous 2 years), and screened positive for current major depression or major depression in partial remission with a score ≥15 on the Hamilton Depression Rating Scale (HDRS). Exclusion criteria included recent treatment for substance abuse, previous treatment for schizophrenia or bipolar disorder, life threatening medical illness, or active treatment for depression by a mental health specialist. 93% of patients completed the blinded telephone assessment at 12 months.


82 physician practices were allocated to the depression management programme (DMP) (n=218), and 81 were allocated to usual care (n=189). DMP consisted of physician education (2 hour training session and psychiatrist consultants at each HMO), patient education (a booklet entitled Depression Isn't Just a Medical Problem and videotaped educational materials), antidepressant treatment (a pharmacotherapy algorithm with adjustment as needed), and treatment coordination.

Main outcome measures

Change in scores on the …

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  • Source of funding: Pfizer Pharmaceuticals Inc.

  • For correspondence: Dr D J Katzelnick, Madison Institute of Medicine, 7617 Mineral Point Road, Madison, WI 53562, USA. Fax +1 608 827 2444.

  • Abstract and commentary also appear in Evidence-Based Mental Health.

  • * See glossary.

  • Information provided by author.