||Williams, J. W., Gerrity, M., Holsinger, T., Dobscha, S., Gaynes, B., & Dietrich, A. (2007). Systematic review of multifaceted interventions to improve depression care. General Hospital Psychiatry, 29(2), 91-116.
||Background: Depression is a leading cause of disability and poor outcomes in primary care settings. Healthcare professionals need quality information about interventions to provide effective care for consumers with depression.
Objectives: To review multifaceted interventions to improve depression outcomes and to identify key components of the interventions, target patients, and vital resources needed for the interventions.
Search strategy: The authors searched Medline, HealthSTAR, CINAHL, PsycINFO, and a specialized registry of depression trials using keywords related to depression and care management. In addition, the authors checked references for related articles and contacted experts.
Selection criteria: Studies were included that met the following criteria: (a) participant(s) diagnosed with depression receiving care in a primary care setting, (b) interventions with at least one patient-directed element from the Wagner’s Chronic Care Model (CCM), and (c) clinically meaningful outcomes (e.g., change in depressive symptoms).
Data collection and analysis: The authors abstracted the retrieved articles according to the components of CCM including setting, subject, components of the intervention, care management functions and process, and outcomes. The authors assessed the methodological quality of each study (e.g., process of randomization and allocation of study participants).
Main results: The authors included 28 studies in the review, and these studies demonstrated good quality overall. Most studies were implemented in a large health care organization and included care management, enhanced mental health involvement, and/or direct patient care. The components of care management varied including general support and education (all studies), communication and coordination of care, monitoring depression symptoms and adherence to treatment plans and medication side effects, and assisting self-management activities. Of 24 studies that evaluated medication adherence, 15 studies showed a significant increase of antidepressant use by a median of 17.8%. Twenty-four studies reported the percentage of patients showing improvement in depressive symptoms. Eight studies showed no significant intervention effects, and six studies reported outcomes beyond 12 months. Fifteen studies reported other outcomes such as less interference with family, work or social activities at 6-24 months.
Conclusions: There is strong evidence to support multifaceted interventions and the benefits of care management on depression outcomes.