TY - JOUR
T1 - Primary versus specialty care outcomes for depressed outpatients managed with measurement-based care
T2 - Results from STAR*D
AU - Gaynes, Bradley N.
AU - Rush, A. John
AU - Trivedi, Madhukar H.
AU - Wisniewski, Stephen R.
AU - Balasubramani, G. K.
AU - McGrath, Patrick J.
AU - Thase, Michael E.
AU - Klinkman, Michael
AU - Nierenberg, Andrew A.
AU - Yates, William R.
AU - Fava, Maurizio
N1 - Funding Information:
This project has been funded with Federal funds from the National Institute of Mental Health, National Institutes of Health, under Contract N01MH90003 to UT Southwestern Medical Center at Dallas (P.I.: A.J. Rush). Dr. Gaynes was supported in part by an NIMH K23 Career Development Award (MH01951-03). The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does the mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The authors’ work was independent of the funders (i.e., the funders had no involvement in the collection, analysis, and interpretation of data nor in the writing of this report or the decision to submit the article).
PY - 2008/5
Y1 - 2008/5
N2 - BACKGROUND: Whether the acute outcomes of major depressive disorder (MDD) treated in primary (PC) or specialty care (SC) settings are different is unknown. OBJECTIVE: To compare the treatment and outcomes for depressed outpatients treated in primary versus specialty settings with citalopram in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study (www.star-d.org), a broadly inclusive effectiveness trial. DESIGN: Open clinical trial with citalopram for up to 14 weeks at 18 primary and 23 specialty sites. Participants received measurement-based care with 5 recommended treatment visits, manualized pharmacotherapy, ongoing support and guidance by a clinical research coordinator, the use of structured evaluation of depressive symptoms and side effects at each visit, and a centralized treatment monitoring and feedback system. PARTICIPANTS: A total of 2,876 previously established outpatients in primary (n=1091) or specialty (n=1785) with nonpsychotic depression who had at least 1 post-baseline measure. MEASUREMENTS AND MAIN RESULTS: Remission (Hamilton Depression Rating Scale for Depression [Hamilton] or 16-item Quick Inventory of Depressive Symptomatology-Self-Rated [QIDS-SR 16]); response (QIDS-SR16); time to first remission (QIDS-SR16). Remission rates by Hamilton (26.6% PC vs 28.0% SC, p=.40) and by QIDS-SR16 (32.5% PC vs 33.1% SC, p=.78) and response rates by QIDS-SR16 (45.7% PC vs 47.6% SC, p=.33) were not different. For those who reached remission or response at exit, the time to remission (6.2 weeks PC vs 6.9 weeks SC, p=.12) and to response (5.5 weeks PC vs 5.4 weeks SC, p=.97) did not differ by setting. CONCLUSIONS: Identical remission and response rates can be achieved in primary and specialty settings when identical care is provided.
AB - BACKGROUND: Whether the acute outcomes of major depressive disorder (MDD) treated in primary (PC) or specialty care (SC) settings are different is unknown. OBJECTIVE: To compare the treatment and outcomes for depressed outpatients treated in primary versus specialty settings with citalopram in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study (www.star-d.org), a broadly inclusive effectiveness trial. DESIGN: Open clinical trial with citalopram for up to 14 weeks at 18 primary and 23 specialty sites. Participants received measurement-based care with 5 recommended treatment visits, manualized pharmacotherapy, ongoing support and guidance by a clinical research coordinator, the use of structured evaluation of depressive symptoms and side effects at each visit, and a centralized treatment monitoring and feedback system. PARTICIPANTS: A total of 2,876 previously established outpatients in primary (n=1091) or specialty (n=1785) with nonpsychotic depression who had at least 1 post-baseline measure. MEASUREMENTS AND MAIN RESULTS: Remission (Hamilton Depression Rating Scale for Depression [Hamilton] or 16-item Quick Inventory of Depressive Symptomatology-Self-Rated [QIDS-SR 16]); response (QIDS-SR16); time to first remission (QIDS-SR16). Remission rates by Hamilton (26.6% PC vs 28.0% SC, p=.40) and by QIDS-SR16 (32.5% PC vs 33.1% SC, p=.78) and response rates by QIDS-SR16 (45.7% PC vs 47.6% SC, p=.33) were not different. For those who reached remission or response at exit, the time to remission (6.2 weeks PC vs 6.9 weeks SC, p=.12) and to response (5.5 weeks PC vs 5.4 weeks SC, p=.97) did not differ by setting. CONCLUSIONS: Identical remission and response rates can be achieved in primary and specialty settings when identical care is provided.
KW - Clinical trial
KW - Depression
KW - Outcomes
KW - Primary care
UR - http://www.scopus.com/inward/record.url?scp=42449088072&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=42449088072&partnerID=8YFLogxK
U2 - 10.1007/s11606-008-0522-3
DO - 10.1007/s11606-008-0522-3
M3 - Article
C2 - 18247097
AN - SCOPUS:42449088072
SN - 0884-8734
VL - 23
SP - 551
EP - 560
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 5
ER -