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Text
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<a href="http://doi.org/10.1111/j.1525-1497.2004.21249.x" target="_blank" rel="noreferrer noopener">http://doi.org/10.1111/j.1525-1497.2004.21249.x</a>
Pages
78–84
Issue
1
Volume
19
Dublin Core
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Title
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Effectiveness of screening and treatment for depression in ambulatory indigent patients.
Publisher
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Journal of general internal medicine
Date
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2004
2004-01
Subject
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*Medical Indigency; Adult; Aged; Ambulatory/statistics & numerical data; Antidepressive Agents/therapeutic use; Blood Pressure Monitoring; Depressive Disorder/*diagnosis/drug therapy/epidemiology; Female; Health Status Indicators; Hospital/*statistics & numerical data; Humans; Male; Mass Screening/*statistics & numerical data; Middle Aged; Outpatient Clinics; Program Evaluation; Quality of Life
Creator
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Jarjoura David; Polen Ann; Baum Elizabeth; Kropp Denize; Hetrick Suzanne; Rutecki Gregory
Description
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OBJECTIVE: To determine the effectiveness of screening and treatment for depression among ambulatory indigent patients visiting resident physicians. DESIGN: Two-group randomized trial (N = 33 intervention, N = 28 usual care) with baseline, 6-month, and 12-month outcome measurements. SETTING: Internal Medicine Residency Clinic. PATIENTS: Clinic patients over 18 years of age who screened positive for depression on the PRIME-MD during a visit to their resident physician. Patients were not receiving treatment nor seeking care for any emotional problems. All patients were either enrolled in Medicaid or had income below the poverty line. INTERVENTION: Resident physicians were educated to follow AHCPR (AHRQ; Agency for Healthcare Research and Quality) guidelines for diagnosis and treatment of depression in a primary care setting. For the intervention group patients, a screening nurse advised residents regarding the positive screen, handed them a standardized protocol outline, and attempted to arrange behavioral care. The patients in the usual care group were provided the results of the screen by the screening nurse before their visit with the resident, and advised to seek care for their symptoms. MAIN RESULTS: Results for the primary outcome of depression symptoms measured with the Beck Depression Inventory (BDI) demonstrated that intervention was successful in reducing symptoms relative to usual care (difference = -4.9 BDI points, P =.05, 95% confidence interval [CI], -9.8 to -0.005 effect size = -0.41). During the 12-month follow-up, 70% of intervention patients were treated for depression (of these, 91% with antidepressants), while 15% of usual care patients were treated with antidepressants for depression. Another 18% of the usual care group had depression noted, but no treatment was identified. BDI differences between intervention and control groups were similar at the 6- and 12-month measures. Quality of life and costs were also measured, but differences between the groups were not significant in this regard. CONCLUSION: Screening and treatment for depression by resident physicians was successful in reducing symptoms relative to usual care in an indigent population. Almost twice as many intervention patients as usual care controls demonstrated a substantial reduction (10 BDI points) in symptoms related to depression.
Identifier
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<a href="http://doi.org/10.1111/j.1525-1497.2004.21249.x" target="_blank" rel="noreferrer noopener">10.1111/j.1525-1497.2004.21249.x</a>
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Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
*Medical Indigency
2004
Adult
Aged
Ambulatory/statistics & numerical data
Antidepressive Agents/therapeutic use
Baum Elizabeth
Blood Pressure Monitoring
College of Medicine
Department of Family & Community Medicine
Depressive Disorder/*diagnosis/drug therapy/epidemiology
Female
Health Status Indicators
Hetrick Suzanne
Hospital/*statistics & numerical data
Humans
Jarjoura David
Journal of general internal medicine
Kropp Denize
Male
Mass Screening/*statistics & numerical data
Middle Aged
NEOMED College of Medicine
Outpatient Clinics
Polen Ann
Program Evaluation
Quality of Life
Rutecki Gregory