The Societal Promise of Improving Care for Depression
RAND HEALTH SANTA MONICA CA
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Depression is now the second-leading cause of disability worldwide. It brings about as much loss in functioning as most chronic diseases, for example, diabetes or heart disease. Depression costs employers more than 51 billion per year in absenteeism and lost productivity, not including high medical and pharmaceutical bills. Treatment medication and psychotherapy is effective for 70 to 80 percent of depressed patients. But studies over the past decade have consistently found low rates of detection and appropriate treatment in primary care settings, where most depressed patients go if they seek care. Overall, only about one-fourth of people with depression receive appropriate treatment -- care that is consistent with accepted clinical guidelines. Rates are particularly low among underserved minority groups. A team of RAND experts, led by Kenneth Wells, designed and evaluated Partners in Care, a real-world trial to determine whether diverse primary care clinics could implement practical programs for improving depression care. Partners in Care PIC evaluated how two quality improvement programs for depression affected quality of care, health-related outcomes, employment, and ethnic disparities in clinical outcomes. The study involved 181 physicians in 46 primary care clinics located across the country. Within each location, the clinics were randomly assigned either to conduct care as usual, or to implement one of two quality improvement interventions medication management or psychotherapy. Their key findings are as follows 1 over two years the quality improvement programs improved the quality of care that patients received 2 the programs also improved patients health and quality of life, and increased the amount of time that patients worked 3 the programs modestly increased health care costs, but they were relatively cost-effective compared with other accepted interventions and 4 the programs reduced ethnic disparities in health outcomes.
- Medicine and Medical Research