Translation of comparative effectiveness of depression medications into practice

DESCRIPTION (provided by applicant): At any one time, there are approximately 16 million Americans with depression, a condition associated with decreased quality and diminished duration of life, and with very large costs for society and for the families affected. Lifestyle changes and self-care practices, interpersonal therapy, and pharmacotherapy can improve depression outcomes and lower costs associated with disability. Depression care often demands primary care clinicians' and patients' use of therapy and medication regimens of different efficacy, safety, cost, and burden to the patient. Comparative effectiveness reviews and clinician and patient guides have become available and can inform patients and clinicians about the relative merits of the available options. Decision aids are tools that could help translate evidence from these CERs into practice by helping clinicians involve patients in making deliberate choices based on accessible information about the options available and their outcomes. Our group has developed and evaluated innovative decision aids for treatment of chronic disease in primary care practices and found that their use promoted patient involvement in choice and adherence to treatment. To determine the ability of decision aids to effectively translate a depression CER into practice, we propose to develop a literacy-sensitive depression treatment decision aid, Depression Choice, that would adapt AHRQ's Effective Healthcare CER and associated patient guide about antidepressant medicines (AHRQ 07-EHC007) to satisfy the needs of clinicians, patients and other major stakeholders (health plans, payers). We also propose a randomized study to estimate the effectiveness of the decision aid on patient knowledge, patient involvement in decision-making and decision-making quality, and 6-month measures of medication adherence and mental health, when compared with usual care. Upon completion of the proposed research, we will have translated the Effective Healthcare CER of depression treatment into a point-of-care decision aid and will have acquired new knowledge about the effectiveness of this decision aid in primary care practices. PUBLIC HEALTH RELEVANCE: (Lay language) Routinely, patients with major depression do not have accessible information about the pros and cons of antidepressants, do not participate in choosing the medicine they will take, do not take their antidepressant, and enjoy less than maximum benefit from this treatment. In this study, a multidisciplinary team plans to adapt the available summary of evidence about antidepressants produced by the AHRQ for use as a decision aid -- a tool that helps patients, including those with low health literacy, understand the pros and cons of these medicines. With active participation from patients, clinicians, and other stakeholders, we will develop the decision aid and test its efficacy in primary care. We hypothesize that use of the decision aid will improve patient knowledge about the options, increase the chance that patients will stick to their choice over time by choosing a medicine that better fits with their context and preferences, and improve their depression outcomes.