TY - JOUR
KW - Adolescent
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Allied Health Personnel
KW - Antidepressive Agents/therapeutic use
KW - Case Management/standards
KW - Depressive Disorder/drug therapy/therapy
KW - Family Practice/organization & administration/standards
KW - Female
KW - Germany
KW - Humans
KW - Interviews as Topic
KW - Male
KW - Medication Adherence
KW - Middle Aged
KW - Outcome and Process Assessment (Health Care)
KW - Prospective Studies
KW - Quality Assurance, Health Care
KW - Questionnaires
KW - Telephone
KW - Young Adult
AU - J. Gensichen
AU - M. Von Korff
AU - M. Peitz
AU - C. Muth
AU - M. Beyer
AU - C. Guthlin
AU - M. Torge
AU - J. J. Petersen
AU - T. Rosemann
AU - J. Konig
AU - F. M. Gerlach
AU - PRoMPT
A1 - 
AB - BACKGROUND: Case management by health care assistants in small primary care practices provides unclear benefit for improving depression symptoms. OBJECTIVE: To determine whether case management provided by health care assistants in small primary care practices is more effective than usual care in improving depression symptoms and process of care for patients with major depression. DESIGN: Cluster randomized, controlled trial. A central automated system generated the randomization scheme, which was stratified by urban and rural practices; allocation sequence was concealed until groups were assigned. SETTING: 74 small primary care practices in Germany from April 2005 to September 2007. PATIENTS: 626 patients age 18 to 80 years with major depression. INTERVENTION: Structured telephone interview to monitor depression symptoms and support for adherence to medication, with feedback to the family physician. MEASUREMENTS: Depression symptoms at 12 months, as measured by the Patient Health Questionnaire-9 (PHQ-9); secondary outcomes were patient assessment of chronic illness care, adherence to medication, and quality of life. RESULTS: A total of 310 patients were randomly assigned to case management and 316 to usual care. At 12 months, 249 intervention recipients and 278 control patients were assessed; 555 patients were included in a modified intention-to-treat-analysis (267 intervention recipients vs. 288 control patients). Compared with control patients, intervention recipients had lower mean PHQ-9 values in depression symptoms (-1.41 [95% CI, -2.49 to -0.33]; P = 0.014), more favorable assessments of care (3.41 vs. 3.11; P = 0.011), and increased treatment adherence (2.70 vs. 2.53; P = 0.042). Quality-of-life scores did not differ between groups. LIMITATION: Patients, health care assistants, family physicians, and researchers were not blinded to group assignment, and 12-month follow-up of patients was incomplete. CONCLUSION: Case management provided by primary care practice-based health care assistants may reduce depression symptoms and improve process of care for patients with major depression more than usual care. PRIMARY FUNDING SOURCE: German Ministry of Education and Research.
BT - Annals of Internal Medicine
C5 - HIT & Telehealth
CP - 6
CY - United States
IS - 6
JF - Annals of Internal Medicine
N2 - BACKGROUND: Case management by health care assistants in small primary care practices provides unclear benefit for improving depression symptoms. OBJECTIVE: To determine whether case management provided by health care assistants in small primary care practices is more effective than usual care in improving depression symptoms and process of care for patients with major depression. DESIGN: Cluster randomized, controlled trial. A central automated system generated the randomization scheme, which was stratified by urban and rural practices; allocation sequence was concealed until groups were assigned. SETTING: 74 small primary care practices in Germany from April 2005 to September 2007. PATIENTS: 626 patients age 18 to 80 years with major depression. INTERVENTION: Structured telephone interview to monitor depression symptoms and support for adherence to medication, with feedback to the family physician. MEASUREMENTS: Depression symptoms at 12 months, as measured by the Patient Health Questionnaire-9 (PHQ-9); secondary outcomes were patient assessment of chronic illness care, adherence to medication, and quality of life. RESULTS: A total of 310 patients were randomly assigned to case management and 316 to usual care. At 12 months, 249 intervention recipients and 278 control patients were assessed; 555 patients were included in a modified intention-to-treat-analysis (267 intervention recipients vs. 288 control patients). Compared with control patients, intervention recipients had lower mean PHQ-9 values in depression symptoms (-1.41 [95% CI, -2.49 to -0.33]; P = 0.014), more favorable assessments of care (3.41 vs. 3.11; P = 0.011), and increased treatment adherence (2.70 vs. 2.53; P = 0.042). Quality-of-life scores did not differ between groups. LIMITATION: Patients, health care assistants, family physicians, and researchers were not blinded to group assignment, and 12-month follow-up of patients was incomplete. CONCLUSION: Case management provided by primary care practice-based health care assistants may reduce depression symptoms and improve process of care for patients with major depression more than usual care. PRIMARY FUNDING SOURCE: German Ministry of Education and Research.
PP - United States
PY - 2009
SN - 1539-3704; 0003-4819
SP - 369
EP - 378
EP - 
T1 - Case management for depression by health care assistants in small primary care practices: a cluster randomized trial
T2 - Annals of Internal Medicine
TI - Case management for depression by health care assistants in small primary care practices: a cluster randomized trial
U1 - HIT & Telehealth
U2 - 19755362
VL - 151
VO - 1539-3704; 0003-4819
Y1 - 2009
ER -