Methodological Issues in the Recruitment of Primary Care Patients with Depression

Nazemi, Hamid; Larkin, Adelpha Abrahamson; Sullivan, Mark D.; Katon, Wayne

doi:10.2190/q8bw-raa7-f2h3-19bf

Cited by 10 publications

(11 citation statements)

References 22 publications

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“…This hybrid method has been recommended as a strategy for balancing between recruitment efficiency and representativeness in health services intervention trials. 27 To be eligible, subjects had to be on the active patient roster at the CMHC, have a severe mental illness, 28 and have the capacity to provide informed consent. Inclusion criteria were purposely kept broad to optimize generalizability to other community mental health settings.…”

Section: Methodsmentioning

confidence: 99%

A Randomized Trial of Medical Care Management for Community Mental Health Settings: The Primary Care Access, Referral, and Evaluation (PCARE) Study

Druss

Esenwein²,

Compton³

et al. 2010

AJP

353

236

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Objective Poor quality of health care contributes to impaired health and excess mortality in individuals with severe mental disorders. This study tests a population-based medical care management intervention to improve primary medical care in community mental health settings. Method A total of 407 subjects with severe mental illnesses at an urban community mental health center were randomized to either care management or usual care. For individuals in the intervention group, care managers provided communication and advocacy with medical providers, health education for patients, and support in overcoming system-level fragmentation and barriers to primary medical care. Results At 12-month follow-up, the intervention group received an average of 58.7% of recommended preventive services, compared to 21.8% in the usual care group (p<0.001). They received a significantly higher proportion of evidence-based services for cardiometabolic conditions (34.9% vs. 27.7%, p=0.03), and were more likely to have a primary care provider (71.2% vs. 51.9%, p=0.003). On the SF-36, the intervention group showed significant improvement on the Mental Component Summary score (8.0% improvement in intervention versus 1.1% decline in the control group, p=0.008) with a nonsigificant improvement on the Physical Component Summary score. Among subjects with available laboratory data, Framingham Cardiovascular Risk Scores were significantly lower (better) for intervention (6.9%) than control (9.8%) subjects (p=0.02). Conclusions Medical care management was associated with significant improvements in quality and outcomes of primary care. The findings suggest that care management is a promising approach for improving medical care for patients treated in community mental health settings. Clinicaltrials.gov identifier NCT00183313

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Section: Methodsmentioning

confidence: 99%

A Randomized Trial of Medical Care Management for Community Mental Health Settings: The Primary Care Access, Referral, and Evaluation (PCARE) Study

Druss

Esenwein²,

Compton³

et al. 2010

AJP

353

236

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“…International comparative epidemiological studies in primary care are particularly rare and are hampered by a number of deficits (Ü stün and Sartorius, 1995;Nazemi et al, 2001;Katon and Schulberg, 1992;Wittchen et al, 2001a and b). Nevertheless, the available evidence from studies conducted in the 1980s and early 1990s in various countries (Katon and Schulberg, 1992) have suggested that depression in primary care is relatively common.…”

Section: Introductionmentioning

confidence: 99%

Prevalence, recognition and management of depression in primary care in Germany: the Depression 2000 study

Wittchen

Pittrow

2002

Hum. Psychopharmacol. Clin. Exp.

167

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'Depression 2000' is a major epidemiological study conducted in a representative sample of 412 primary care settings (which examined a total of 15,081 unselected patients) in Germany in order to address the current lack of information on the prevalence, recognition and treatment of depression in primary care. The study revealed that depression is a key challenge in primary care because of its prevalence (point prevalence according to ICD-10: 10.9%), type of presenting complaints and the time constraints of the doctors. Participating doctors had a very high workload (average of 62 patients per day) and perceived the management of depressed patients as a major burden. The majority of cases of depression identified met criteria for moderate or severe depression, and 51% had a chronic and/or recurrent course. A total of 55% of patients were correctly diagnosed as having a clinically significant depressive disorder, although only 21% received a diagnosis of 'definite' depression. In conclusion, these findings confirm the high prevalence of depressive disorders in primary care settings and underline the particular challenges posed by these patients. Although recognition rates among more severe major depressive patients, as well as treatments prescribed, appear to be more favourable than in previous studies, the high proportion of unrecognised patients with definite depression still raises significant concerns. It remains of continued prime importance to educate primary care doctors to better recognise depression in order to increase the patients' chances of receiving appropriate treatment.

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“…That said, we were aware that studies like ours, involving waiting room screening, may offer a less popular mode of recruitment to older people (relative to recruitment by GP). 3 The latter method would clearly not have been appropriate in our study, but the option to take home materials may have helped to minimise this effect. Bahri and Hilton's inappropriate extrapolation of our statistics ('this suggests that almost no participants were over the age of 65 years') is wholly incorrect.…”

Section: Authors' Responsementioning

confidence: 88%

Authors' response

Cameron¹,

Lawton²,

Reid³

2010

Br J Gen Pract

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Methodological Issues in the Recruitment of Primary Care Patients with Depression

Cited by 10 publications

References 22 publications

A Randomized Trial of Medical Care Management for Community Mental Health Settings: The Primary Care Access, Referral, and Evaluation (PCARE) Study

A Randomized Trial of Medical Care Management for Community Mental Health Settings: The Primary Care Access, Referral, and Evaluation (PCARE) Study

Prevalence, recognition and management of depression in primary care in Germany: the Depression 2000 study

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