In primary care settings, the effective implementation of comparative research findings regarding antidepressants remains a significant challenge. This gap between evidence and practice negatively impacts the quality of care and outcomes for individuals grappling with depression. To address this critical issue, the Depression Medication Choice (DMC) encounter decision aid was developed. This tool is specifically designed to facilitate collaborative discussions between patients and clinicians, focusing on available antidepressant options and their potential to alleviate depression and address other patient-centric concerns.
This study aimed to evaluate the effectiveness of the DMC decision aid in enhancing the quality of the decision-making process and improving depression-related outcomes for patients.
A cluster randomized trial was conducted across ten primary care practices, encompassing rural, suburban, and urban settings in Minnesota and Wisconsin. Adult patients experiencing moderate to severe depression, who were considering antidepressant treatment, were enrolled in the study. Practices were randomly assigned to either implement the DMC decision aid or continue with usual care practices for depression treatment.
The DMC decision aid, the intervention in this study, is comprised of a series of cards. Each card details the effects of different antidepressant options on aspects that are important to patients. These cards are intended to be used during face-to-face consultations to guide the discussion.
The primary outcome measures focused on the quality of decision-making. This was assessed through patient knowledge, the extent of patient involvement in decision-making, patient and clinician decisional comfort (measured using the Decisional Conflict Scale), patient satisfaction, and the duration of the clinical encounter. Secondary measures included medication adherence, depression symptoms, and scores on the Patient Health Questionnaire for depression (PHQ-9).
The study involved 117 clinicians and 301 patients, with a majority being women (67%) and an average age of 44 years. The average baseline PHQ-9 score was 15, indicating moderate to severe depression. The results demonstrated that the use of the DMC decision aid significantly improved several aspects of the decision-making process compared to usual care. Patients in the DMC group reported higher decisional comfort (80% vs 75%; P = .02), greater knowledge about their options (65% vs 56%; P = .03), increased satisfaction (risk ratio [RR], from 1.25 [P = .81] to RR, 2.4 [P = .002] depending on the satisfaction domain), and a higher level of involvement in the decision-making process (47% vs 33%; P < .001). Notably, the use of the DMC tool did not extend the duration of patient encounters. However, the study found no significant difference between the DMC and usual care groups in terms of medication adherence or improvements in depression outcomes.
In conclusion, the DMC decision aid is an effective tool for primary care clinicians and patients with moderate to severe depression to collaboratively select antidepressants. It significantly enhances the quality of the decision-making process without adding to consultation time. By effectively translating comparative effectiveness research into patient-centered care, the integration of DMC tools can lead to improved quality of primary care for patients with depression, focusing on informed and shared decision making.
Trial registration: clinicaltrials.gov Identifier: NCT01502891
