Partners in Care

Key aims: Partners in Care was designed to improve the quality of care for depression in managed, primary care practices. The study evaluated the effects of two quality improvement (QI) interventions on patient health outcomes, patient satisfaction, health care, social costs, quality of care, and cost-effectiveness of care. One program directed QI resources toward supporting medication treatment; the other directed resources toward supporting psychotherapy.

Methods: Partners in Care is a group-level, randomized trial comparing two quality improvement interventions for depressed primary care patients to usual care. The study was conducted in different geographic areas of the United States and involves over 27,000 patients, 181 providers, and 43 general medical clinics. Clinics were assigned to either conduct care as they usually would or to participate in programs that provide education to patients and providers and provide specially trained clinical staff. Patients were asked to complete a brief survey, participate in a two-year study of their health care, and/or give permission to the study to review their medical records and insurance billing information.

Significance: The information from this study will help participating health care providers and similar providers know how to improve the quality of life and mental health of their patients.

Impact: The quality-improvement programs significantly increased the rates of counseling and appropriate use of antidepressant medication. In particular, among patients initially not in treatment for depression, participants in the quality improvement programs were about twice as likely to start either type of treatment in the first six months of follow-up than were patients in the care-as-usual clinics. Patients in the intervention programs were also less likely to be clinically depressed over an 18-24 month period and reported better quality of life. Within the first year, clinical outcome benefits were greater for minorities than for Whites. In the therapy-resource intervention, health benefits continued into the second year; and within the medication-resource intervention, antidepressant medication use was greater in the second year compared to care-as-usual. Even more striking from a policy perspective is how the programs affect employment. For patients who were employed when the study began, the programs promote continued employment. Five percent more of the patients in the quality-improvement programs remained in the workforce at 12 months than did their care-as-usual counterparts. Remaining employed is a crude measure of productivity. However, it is particularly policy-relevant, since most private insurance is through employment. No other quality-improvement evaluation for any condition in primary care has shown that kind of positive employment boost.

Current status: Follow-up studies of Partners in Care participants are underway, e.g., 5-year follow-up is being analyzed under an NIMH grant.