Primary care patients' involvement in decision-making is associated with improvement in depression

Sarah Clever, Daniel E Ford, Lisa V. Rubenstein, Kathryn M. Rost, Lisa S. Meredith, Cathy D. Sherbourne, Nae Yuh Wang, Jose J. Arbelaez, Lisa A Cooper

Research output: Contribution to journalArticle

Abstract

Background: Depression is undertreated in primary care settings. Little research investigates the impact of patient involvement in decisions on guideline-concordant treatment and depression outcomes. Objective: The objective of this study was to determine whether patient involvement in decision-making is associated with guideline-concordant care and improvement in depression symptoms. Design: Prospective cohort study. Setting: Multisite, nationwide randomized clinical trial of quality improvement strategies for depression in primary care. Subjects: Primary care patients with current symptoms and probable depressive disorder. Measurements: Patients rated their involvement in decision-making (IDM) about their care on a 5-point scale from poor to excellent 6 months after entry into the study. Depressive symptoms were measured every 6 months for 2 years using a modified version of the Center for Epidemiologic Studies-Depression (CES-D) scale. We examined probabilities (Pr) of receipt of guideline-concordant care and resolution of depression across IDM groups using multivariate logistic regression models controlling for patient and provider factors. Results: For each 1-point increase in IDM ratings, the probability of patients' report of receiving guideline-concordant care increased 4% to 5% (adjusted Pr 0.31 vs. 0.50 for the lowest and highest IDM ratings, respectively, P <0.001). Similarly, for each 1-point increase in IDM ratings, the probability of depression resolution increased 2% to 3% (adjusted Pr 0.10 vs. 0.19 for the lowest and highest IDM ratings respectively, P = 0.004). Conclusions: Depressed patients with higher ratings of involvement in medical decisions have a higher probability of receiving guideline-concordant care and improving their symptoms over an 18-month period. Interventions to increase patient involvement in decision-making may be an important means of improving care for and outcomes of depression.

Original languageEnglish (US)
Pages (from-to)398-405
Number of pages8
JournalMedical Care
Volume44
Issue number5
DOIs
StatePublished - May 2006

Fingerprint

Patient Participation
patient care
Primary Health Care
Decision Making
Depression
decision making
Guidelines
rating
Logistic Models
Depressive Disorder
Quality Improvement
Epidemiologic Studies
Cohort Studies
Randomized Controlled Trials
Prospective Studies
logistics

Keywords

  • Depression
  • Patient involvement in care
  • Patient-centered care
  • Primary care
  • Shared decision-making

ASJC Scopus subject areas

  • Nursing(all)
  • Public Health, Environmental and Occupational Health
  • Health(social science)
  • Health Professions(all)

Cite this

Primary care patients' involvement in decision-making is associated with improvement in depression. / Clever, Sarah; Ford, Daniel E; Rubenstein, Lisa V.; Rost, Kathryn M.; Meredith, Lisa S.; Sherbourne, Cathy D.; Wang, Nae Yuh; Arbelaez, Jose J.; Cooper, Lisa A.

In: Medical Care, Vol. 44, No. 5, 05.2006, p. 398-405.

Research output: Contribution to journalArticle

Clever, Sarah ; Ford, Daniel E ; Rubenstein, Lisa V. ; Rost, Kathryn M. ; Meredith, Lisa S. ; Sherbourne, Cathy D. ; Wang, Nae Yuh ; Arbelaez, Jose J. ; Cooper, Lisa A. / Primary care patients' involvement in decision-making is associated with improvement in depression. In: Medical Care. 2006 ; Vol. 44, No. 5. pp. 398-405.
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abstract = "Background: Depression is undertreated in primary care settings. Little research investigates the impact of patient involvement in decisions on guideline-concordant treatment and depression outcomes. Objective: The objective of this study was to determine whether patient involvement in decision-making is associated with guideline-concordant care and improvement in depression symptoms. Design: Prospective cohort study. Setting: Multisite, nationwide randomized clinical trial of quality improvement strategies for depression in primary care. Subjects: Primary care patients with current symptoms and probable depressive disorder. Measurements: Patients rated their involvement in decision-making (IDM) about their care on a 5-point scale from poor to excellent 6 months after entry into the study. Depressive symptoms were measured every 6 months for 2 years using a modified version of the Center for Epidemiologic Studies-Depression (CES-D) scale. We examined probabilities (Pr) of receipt of guideline-concordant care and resolution of depression across IDM groups using multivariate logistic regression models controlling for patient and provider factors. Results: For each 1-point increase in IDM ratings, the probability of patients' report of receiving guideline-concordant care increased 4{\%} to 5{\%} (adjusted Pr 0.31 vs. 0.50 for the lowest and highest IDM ratings, respectively, P <0.001). Similarly, for each 1-point increase in IDM ratings, the probability of depression resolution increased 2{\%} to 3{\%} (adjusted Pr 0.10 vs. 0.19 for the lowest and highest IDM ratings respectively, P = 0.004). Conclusions: Depressed patients with higher ratings of involvement in medical decisions have a higher probability of receiving guideline-concordant care and improving their symptoms over an 18-month period. Interventions to increase patient involvement in decision-making may be an important means of improving care for and outcomes of depression.",
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AU - Clever, Sarah

AU - Ford, Daniel E

AU - Rubenstein, Lisa V.

AU - Rost, Kathryn M.

AU - Meredith, Lisa S.

AU - Sherbourne, Cathy D.

AU - Wang, Nae Yuh

AU - Arbelaez, Jose J.

AU - Cooper, Lisa A

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AB - Background: Depression is undertreated in primary care settings. Little research investigates the impact of patient involvement in decisions on guideline-concordant treatment and depression outcomes. Objective: The objective of this study was to determine whether patient involvement in decision-making is associated with guideline-concordant care and improvement in depression symptoms. Design: Prospective cohort study. Setting: Multisite, nationwide randomized clinical trial of quality improvement strategies for depression in primary care. Subjects: Primary care patients with current symptoms and probable depressive disorder. Measurements: Patients rated their involvement in decision-making (IDM) about their care on a 5-point scale from poor to excellent 6 months after entry into the study. Depressive symptoms were measured every 6 months for 2 years using a modified version of the Center for Epidemiologic Studies-Depression (CES-D) scale. We examined probabilities (Pr) of receipt of guideline-concordant care and resolution of depression across IDM groups using multivariate logistic regression models controlling for patient and provider factors. Results: For each 1-point increase in IDM ratings, the probability of patients' report of receiving guideline-concordant care increased 4% to 5% (adjusted Pr 0.31 vs. 0.50 for the lowest and highest IDM ratings, respectively, P <0.001). Similarly, for each 1-point increase in IDM ratings, the probability of depression resolution increased 2% to 3% (adjusted Pr 0.10 vs. 0.19 for the lowest and highest IDM ratings respectively, P = 0.004). Conclusions: Depressed patients with higher ratings of involvement in medical decisions have a higher probability of receiving guideline-concordant care and improving their symptoms over an 18-month period. Interventions to increase patient involvement in decision-making may be an important means of improving care for and outcomes of depression.

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