A randomized trial using computerized decision support to improve treatment of major depression in primary care

• HIT Description: Electronic health record and decision support with guidelines and reminders. More info...
  
• Purpose of Study: Study whether feedback and treatment advice for depression presented to primary care physicians via an electronic medical record (EMR) system can potentially improve clinical outcomes and care processes for patients with major depression.
  
• Years of study: 1997-1999
  
• Study Design: RCT
  
• Outcomes: Impact on health care effectivness/quality
  

• Settings: The study was conducted at an academically affiliated primary care practice in Pittsburgh, PA, and 200 primary care patients with major depression participated in the study.
• Intervention: The study groups consisted of 3 levels of exposure to EMR feedback of guideline-based treatment advice for depression: "active care" (AC), "passive care" (PC), or "usual care" (UC).
• Evaluation Method: Measures of depression, and chart review of PCP reports of depression care in the 6 months following the depression diagnosis.
• HIT System: o The EMR used was ÒÓLogicianÓ (Version 4.2: Medicalogic, Beaverton, Oregon), and it was implemented 9 months before the implementation of the electronic guideline system, which was in the accessed through the ÒIntranetÓ site.
• Clinical Outcomes: No statistically significant difference in depression symptoms scores or on the delivery of recommended processes of depression care were found for either intervention group when compared to usual care (Replace: Only 22% of patients recovered from their depressive episode at 6 months (HRS-D /=3 contacts with usual PCP at 6 months: 31% AC, 31% PC, 18% UC; P =.09 and antidepressant medication suggested/prescribed or baseline regimen modified at 6 months: 59% AC, 57% PC, 52% UC; P =.3)
• Quality of Care and Patient Safety Outcome: Only 22% of patients recovered from their depressive episode at 6 months (HRS-D /=3 contacts with usual PCP at 6 months: 31% AC, 31% PC, 18% UC; P =.09 and antidepressant medication suggested/prescribed or baseline regimen modified at 6 months: 59% AC, 57% PC, 52% UC; P =.3).