Do the effects of quality improvement for depression care differ for men and women? Results of a group-level randomized controlled trial

Objective: We sought to examine whether a quality improvement (QI) program for depression care is effective for both men and women and whether their responses differed. Design: We instituted a group-level, randomized, controlled trial in 46 primary care practices within 6 managed care organizations. Clinics were randomized to usual care or to 1 of 2 QI programs that supported QI teams, provider training, nurse assessment and patient education, and resources to support medication management (QIMeds) or psychotherapy (QI-Therapy). Patients: There were 1299 primary care patients who screened positive for depression and completed at least one questionnaire during the course of 24 months. Outcome Measures: Outcomes were probable depression, mental health-related quality of life (HRQOL), work status, use of any antidepressant or psychotherapy, and probable unmet need, which was defined as having probable depression but not receiving probable appropriate care. Results: Women were more likely to receive depression care than men over time, regardless of intervention status. The effect QI-Meds on probable unmet need was delayed for men, and the magnitude of the effect was significantly greater for men than for women; therefore, this intervention reduced differences in probable unmet need between men and women. QI reduced the likelihood of probable depression equally for men and women. QI-Therapy had a greater impact on mental HRQOL and work status for men than for women. QI-Meds improved these outcomes for women. Conclusions: To affect both quality and outcomes of care for men and women while reducing gender differences, QI programs may need to facilitate access to both medication management and effective psychotherapy for depression.