TY - JOUR
KW - Adolescent
KW - Adult
KW - Depressive Disorder/diagnosis/therapy
KW - Evidence-Based Medicine
KW - Female
KW - Guideline Adherence
KW - Humans
KW - internal medicine
KW - Male
KW - Medical Records Systems, Computerized
KW - Middle Aged
KW - Physicians, Family
KW - Practice Guidelines as Topic
KW - Questionnaires
AU - B. L. Rollman
AU - B. H. Hanusa
AU - T. Gilbert
AU - H. J. Lowe
AU - W. N. Kapoor
AU - H. C. Schulberg
A1 - 
AB - BACKGROUND: Inadequate treatments are reported for depressed patients cared for by primary care physicians (PCPs). Providing feedback and evidence-based treatment recommendations for depression to PCPs via electronic medical record improves the quality of interventions. METHODS: Patients presenting to an urban academically affiliated primary care practice were screened for major depression with the Primary Care Evaluation of Mental Disorders (PRIME-MD). During 20-month period, 212 patients met protocol-eligibility criteria and completed a baseline interview. They were cared for by 16 board-certified internists, who were electronically informed of their patients' diagnoses, and randomized to 1 of 3 methods of exposure to guideline-based advice for treating depression (active, passive, and usual care). Ensuing treatment patterns were assessed by medical chart review and by patient self-report at baseline and 3 months. RESULTS: Median time for PCP response to the electronic message regarding the patient's depression diagnosis was 1 day (range, 1-95 days). Three days after notification, 120 (65%) of 186 PCP responses indicated agreement with the diagnosis, 24 (13%) indicated disagreement, and 42 (23%) indicated uncertainty. Primary care physicians who agreed with the diagnoses sooner were more likely to make a medical chart notation of depression, begin antidepressant medication therapy, or refer to a mental health specialist (P<.001). There were no differences in the agreement rate or treatments provided across guideline exposure conditions. CONCLUSIONS: Electronic feedback of the diagnosis of major depression can affect PCP initial management of the disorder. Further study is necessary to determine whether this strategy, combined with delivery of treatment recommendations, can improve clinical outcomes in routine practice.
BT - Archives of Internal Medicine
C5 - HIT & Telehealth
CP - 2
CY - United States
IS - 2
JF - Archives of Internal Medicine
N2 - BACKGROUND: Inadequate treatments are reported for depressed patients cared for by primary care physicians (PCPs). Providing feedback and evidence-based treatment recommendations for depression to PCPs via electronic medical record improves the quality of interventions. METHODS: Patients presenting to an urban academically affiliated primary care practice were screened for major depression with the Primary Care Evaluation of Mental Disorders (PRIME-MD). During 20-month period, 212 patients met protocol-eligibility criteria and completed a baseline interview. They were cared for by 16 board-certified internists, who were electronically informed of their patients' diagnoses, and randomized to 1 of 3 methods of exposure to guideline-based advice for treating depression (active, passive, and usual care). Ensuing treatment patterns were assessed by medical chart review and by patient self-report at baseline and 3 months. RESULTS: Median time for PCP response to the electronic message regarding the patient's depression diagnosis was 1 day (range, 1-95 days). Three days after notification, 120 (65%) of 186 PCP responses indicated agreement with the diagnosis, 24 (13%) indicated disagreement, and 42 (23%) indicated uncertainty. Primary care physicians who agreed with the diagnoses sooner were more likely to make a medical chart notation of depression, begin antidepressant medication therapy, or refer to a mental health specialist (P<.001). There were no differences in the agreement rate or treatments provided across guideline exposure conditions. CONCLUSIONS: Electronic feedback of the diagnosis of major depression can affect PCP initial management of the disorder. Further study is necessary to determine whether this strategy, combined with delivery of treatment recommendations, can improve clinical outcomes in routine practice.
PP - United States
PY - 2001
SN - 0003-9926; 0003-9926
SP - 189
EP - 197
EP - 
T1 - The electronic medical record. A randomized trial of its impact on primary care physicians' initial management of major depression [corrected]
T2 - Archives of Internal Medicine
TI - The electronic medical record. A randomized trial of its impact on primary care physicians' initial management of major depression [corrected]
U1 - HIT & Telehealth
U2 - 11176732
VL - 161
VO - 0003-9926; 0003-9926
Y1 - 2001
ER -