Excerpt

Current clinical guidelines for depression address depression treatment for patients detected in primary care and NICE guidelines. Research to date indicates that, under usual care conditions, less than half of primary care patients found to have major depression complete minimally adequate medications or psychotherapy. A variety of organizational changes aimed at improving care for depression in primary care have been tested. Yet evidence-based guidance for healthcare organizations and their primary care practices about which organizational changes are necessary for achieving improved depression outcomes is lacking. The purpose of this review is to establish a basis for organizational guidelines or best practices for achieving improved depression care.

Contents

• EXECUTIVE SUMMARY
  • BACKGROUND
  • METHODS
  • RESULTS
  • CONCLUSIONS
• EVIDENCE REPORT
  • INTRODUCTION
  • BACKGROUND
  • METHODS
  • METHODOLOGICAL OVERVIEW
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • EXAMPLE TABLE FOR HOW IMPACT RATINGS WERE CARRIED OUT
  • STUDY QUALITY ASSESSMENT
  • DATA SYNTHESIS AND ANALYSIS
  • QUALITATIVE ANALYSIS
  • PEER REVIEW
• RESULTS
  • LITERATURE FLOW
  • STUDIES INCLUDED IN EFFECT SIZE OR RELATIVE RISK ANALYSES
  • CORRELATIONS BETWEEN FEATURES
  • OVERALL EFFECTIVENESS
  • STUDY EVALUATION DESIGN FEATURES VS. EFFECTIVENESS
  • ASSOCIATIONS BETWEEN INTERVENTION FEATURES AND OUTCOME EFFECT SIZES
  • IMPACT MEASURE
  • QUALITATIVE ANALYSIS OF INTERVENTION FEATURES VERSUS OUTCOME IMPACTS
  • QUALITATIVE ANALYSIS OF EVALUATION DESIGN FEATURES, INCLUDING PATIENT COMORBIDITY, VERSUS OUTCOME IMPACTS
  • LIMITATIONS
  • CONCLUSIONS
• APPENDIX A Selected Studies
• APPENDIX B Peer Review Table
• REFERENCES

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Greater Los Angeles Veterans Affairs Healthcare System/Southern California/RAND Evidence-based Practice Center, Los Angeles, CA.

This report is based on research conducted by the Greater Los Angeles Veterans Affairs Healthcare System and Southern California Evidence-based Practice Center (EPC) under contract to the Department of Veterans Affairs. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs.

This report is intended as a reference and not as a substitute for clinical judgment.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. The Department of Veterans Affairs endorsement of such derivative products may not be stated or implied.