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 language | English (US) |
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Pages (from-to) | 398-405 |
Number of pages | 8 |
Journal | Medical care |
Volume | 44 |
Issue number | 5 |
DOIs | |
State | Published - May 2006 |
Keywords
- Depression
- Patient involvement in care
- Patient-centered care
- Primary care
- Shared decision-making
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health