Table 1 Evidence table of included studies

Aakhus [84]; Aakhus, 2014 [85] Country: Norway Setting: primary care office

Randomization unit: municipality

Number of sites: 51 municipalities (26 intervention, 28 control)

Providers: 124 (51 intervention, 73 control) PCPs

Patients: 134 (66 intervention, 68 control) home-dwelling elderly patients 65 years or older

Diagnosis: depression (clinical diagnosis)

Intervention: outreach visits to GPs; website that provided recommendations, tools to diagnose and manage elderly patients with depression, and online courses; CME course approved by the Norwegian Medical Association; tailored information based on profession or relation to the healthcare

Comparator: UC

Timing of follow-up: 8 months

Provider behaviors:

Mean adherence to recommendations for the management of depression at 8 months*

MD − 5.00 (95% CI − 11.87, 1.87)

Patient health outcomes:

Adherence to antidepressant > 0 at 8 months OR 1.33 (95% CI 0.88, 2.00)

GP assessed CGI-I at 8 months MD 0.03 (95% CI − 0.20, 0.26)

HADS depression at 8 months MD − 0.28 (95% CI − 1.87, 1.31)

Patient assessed PGI at 8 months MD 0.10 (95% CI − 0.38, 0.58)

Azocar [86]

Country: USA

Setting: managed behavioral health care organization (specialty care)

Randomization unit: provider

Number of sites: NR

Providers: 443 (162 guidelines only, 132 targeted guidelines, 149 control) mental health care providers

Patients: 836 (273 guidelines only, 254 targeted guidelines, 309 control) all adult patients starting a new episode of care with a study clinician

Diagnosis: MDD

Intervention: general guidelines or targeted guidelines. Guidelines based on United Behavioral Health best practice guidelines (based on APA and AHRQ guidelines)

Comparator: UC

Timing of follow-up: 4 months

Provider behaviors:

Mean adjusted adherence rating (subjective) at 4 months*

--General dissemination of guidelines vs no dissemination, MD − 0.03 (95% CI not calculable)

--Target dissemination vs no dissemination, MD 0.11 (95% CI not calculable)

Units of service (indicators of guideline adherence): combined outpatient at 4 months

--General dissemination of guidelines vs no dissemination, MD 0.20 (95% CI − 0.65, 1.05)

--Target dissemination vs no dissemination, MD − 0.40 (95% CI − 1.25, 0.45)

Units of service (indicators of guideline adherence): outpatient medication at 4 months

--General dissemination of guidelines vs no dissemination, MD 0.00 (95% CI − 0.43, 0.43)

--Target dissemination vs no dissemination, MD − 0.30 (95% CI − 0.74, 0.14)

Units of service (indicators of guideline adherence):outpatient psychotherapy at 4 months

--General dissemination of guidelines vs no dissemination, MD 0.20 (95% CI − 0.62, 1.02)

--Target dissemination vs no dissemination, MD 0.10 (95% CI − 0.75, 0.95)

Patient health outcomes: NR

Baker [57]

Country: England

Setting: primary care office

Randomization unit: site

Number of sites: 60 (30 intervention, 30 control)

Number of providers: 64 (34 intervention, 30 control)

Provider target category: PCP

Patients: 402 (210 intervention, 192 control) aged 18 or above attending for their first consultation with new episodes of depression.

Diagnosis: depression

Intervention: guideline distribution plus tailored implementation. Guidelines developed from existing guidelines and literature reviews

Comparator: other (control group received guidelines but did not receive implementation recommendations)

Timing of follow-up: 12 months

Provider behaviors:

Antidepressant in therapeutic dose at 12 months OR 1.12 (95% CI 0.99, 1.26)

Diagnosis: 3 or more symptoms recorded at 12 months OR 1.25 (95% CI 1.03, 1.53)

Reviewed at 3 weeks at 12 months OR 1.04 (95% CI 0.92, 1.18)

Suicide risk assessed at diagnosis at 12 months OR 2.51 (95% CI 1.93, 3.26)

Those treated are to have two or more follow-up consultations at 12 months OR 1.32 (95% CI 1.07, 1.64)

Treated for 4 months at 12 months OR 1.28 (95% CI 1.00, 1.63)

Treated with antidepressant or cognitive therapy at 12 months* OR 1.03 (95% CI 0.98, 1.08)

Patient health outcomes:

BDI < 11 at 16 week at 12 months OR 1.07 (95% CI 0.77, 1.47)

BDI < 11 at 4 weeks at 12 months OR 0.83 (95% CI 0.51, 1.34)

BDI < 11 at diagnosis at 12 months OR 0.61 (95% CI 0.18, 2.14)

Bosmans [79]; Bijl, 2003 [80]

Country: Netherlands

Setting: primary care office

Randomization unit: Site

Number of sites: 34 (18 intervention, 16 control)

Providers: Number NR; PCPs

Patients: 145 (70 intervention, 75 control) all consecutive patients 55 years and older visiting their GP

Diagnosis: depression (rating scale); Geriatric Depression Scale-15 score of 5 or higher

Intervention: training session based on the Dutch depression guideline

Comparator: UC

Timing of follow-up: 12 months

Provider behaviors:

Received some form of mental health care (antidepressant medication or referral during the follow-up period) at 12 months*

--Practitioners training group vs control group, OR 6.64 (95% CI 3.42, 12.90)

Patient health outcomes:

% (No.) recovered (PRIME-MD) at 12 months OR 0.90 (95% CI 0.61, 1.33)

Mean QALYs gained (EQ-5D) at 12 months MD 0.05 (95% CI − 0.02, 0.12)

Mean improvement in MADRS score at 12 months MD − 0.60 (95% CI − 3.76, 2.56)

Callahan [81]

Country: USA

Setting: primary care office

Randomization unit: patient

Number of sites: 1

Providers: 103 (number per experimental condition NR) PCPs

Patients: 175 (100 intervention, 75 control) aged 60 and older

Diagnosis: Depression (rating scale); ≥ 16 on the CES-D and ≥ 15 on the HAM-D

Intervention: Receipt of patient assessment feedback with recommended care. Recommendations based on literature review and expert panel consensus

Comparator: UC

Timing of follow-up: 6 months

Provider behaviors:

Received a depression diagnosis at 6 months OR 2.67 (95% CI 1.36, 5.23)

Received a psychiatry referral at 6 months 0.88 (95% CI 0.41, 1.92)

Remain on antidepressants at 6 months OR 1.74 (95% CI 1.01, 2.99)

Started antidepressants at 6 months OR 3.25 (95% CI 1.41, 7.50)

Stopped drugs associated with depression at 6 months* OR 1.05 (95% CI 0.60, 1.82)

Patient health outcomes:

HAM-D ≤ 10 at 6 months (responder) at 6 months OR 1.08 (95% CI 0.49, 2.40)

HAM-D score at 1 month MD 0.20 (95% CI not calculable)

HAM-D score at 3 months MD 0.00 (95% CI not calculable)

HAM-D score at 6 months MD 0.40 (95% CI not calculable)

HAM-D score at 9 months MD 0.60 (95% CI not calculable)

Datto [53]

Country: USA

Setting: primary care office

Randomization unit: site

Number of sites: 35 (17 diseases management, 18 education and guidelines)

Providers: 130 (74 disease management, 77 education and guidelines) other general practitioner or clinician

Patients: 61 (30 disease management, 31 education and guidelines)

Diagnosis: depression (rating scale); CES-D ≥ 16

Intervention: Provider education and distribution of practice guidelines from the AHRQ practice guidelines for major depression in primary care

Comparator: Other (education and practice guidelines plus nurse disease management)

Timing of follow-up: 16 weeks

Provider behaviors:

Clinical adherence, when controlling for symptom improvement at 16 weeks OR 0.18 (95% CI 0.05, 0.67)

Clinician adherence through 12 weeks at 16 weeks* OR 0.30 (95% CI 0.08, 1.14)

Clinician adherence through 12 weeks, including only patients who required treatment adjustment (n = 34) at 16 weeks OR 0.14 (95% CI 0.02, 0.97)

Patient adherence through 12 weeks at 16 weeks OR 0.16 (95% CI 0.02, 1.39)

Symptom improvement (CES-D < 16) at 16 weeks OR 0.25 (95% CI 0.08, 0.77)

Symptom improvement (CES-D < 16) when controlling for clinician adherence, active and passive adherence at 16 weeks OR 0.71 (95% CI 0.10, 1.43)

Patient health outcomes:

CES-D score at 16 weeks MD 4.50 (95% CI − 0.90, 9.90)

Proportion meeting major depression (MINI) at 16 weeks OR 1.92 (95% CI 0.49, 7.69)

Proportion of patients below CES-D 11 at follow-up at 16 weeks OR 0.29 (95% CI 0.07, 1.18)

Proportion of patients below CES-D 16 at follow-up at 16 weeks OR 0.15 (95% CI 0.04, 0.64)

Proportion with at least 50% reduction in CES-D at 16 weeks OR 0.25 (95% CI 0.06, 1.09)

Eccles [87]

Country: UK

Setting: Primary care trusts

Randomization unit: Site

Number of sites: 73 (36 intervention, 37 control)

Providers: 266 (128 intervention, 138 control) PCPs

Patients: number and description NR

Diagnosis: unclear

Intervention: guideline distribution with outreach visits. Guidelines developed by a multidisciplinary panel

Comparator: other (guideline distribution only)

Timing: 12 months/6 quarters

Provider behaviors:

Items prescribed per ASTROPU: MAOIs (mean difference between intervention and control) at 6 quarters MD 0.00 (95% CI − 0.02, 0.02)

Items prescribed per ASTROPU: SSRIs (mean difference between intervention and control) at 6 quarters MD 0.03 (95% CI − 0.27, 0.34)

Items prescribed per ASTROPU: lofepramine (mean difference between intervention and control) at 6 quarters MD − 0.02 (95% CI − 0.16, 0.11)

Items prescribed per ASTROPU: other TCAs (mean difference between intervention and control) at 6 quarters* MD − 0.02 (95% CI − 0.46, 0.42)

Number of items prescribed per ASTROPU: MAOIs at 12 months MD − 0.01 (95% CI − 0.04, 0.02)

Number of items prescribed per ASTROPU: other TCAs at 12 months MD 0.23 (95% CI − 1.38, 1.84)

Number of items prescribed per ASTROPU: SSRIs at 12 months MD 0.41 (95% CI − 0.70, 1.52)

Number of items prescribed per ASTROPU lofepramine at 12 months MD 0.05 (95% CI − 0.28, 0.38)

Patient health outcomes: NR

Freemantle [83]; Nazareth, 2002 [88]

Country: UK

Setting: general practices in health authorities (primary care)

Randomization unit: site

Number of sites: 12 health authorities paired in groups of 2 randomized to receive 2 of 4 guidelines (3 pairs received antidepressant guidelines, 3 did not). 75 practices (intervention and control Ns NR)

Providers: 162 (N per condition NR) PCPs

Patients: 11,328 (N per condition not NR). Description NR

Diagnosis: unclear

Intervention: outreach visits for providers. Guidelines developed from techniques by the North of England Guidelines Development Project and literature review

Comparator: other (practices in 12 health authorities were trained in 2 of 4 guidelines; 3 of 6 health authority pairs did not receive training in antidepressant guideline)

Timing of follow-up: 6 months

Provider behaviors:

Number of GPs reporting application of content at 6 months* OR 0.61 (95% CI 0.42, 0.91)

Patient health outcomes: NR

Gerrity [82]

Country: USA

Setting: primary care office

Randomization unit: provider

Number of sites: NR

Providers: 56 (27 intervention, 29 control) PCPs

Number of patients: 2 SPs played by 3 actors

Diagnosis: unclear

Intervention: depression education training sessions. Guidelines based on AHCPR’s CPG for Depression in Primary Care

Comparator: wait-list

Timing of follow-up: 6 weeks

Provider behaviors:

Physician discussed possibility of depression with “patient 1” at 6 weeks* OR 1.48 (95% CI 1.06, 2.06)

Physician discussed possibility of depression with “patient 2” at 6 weeks* OR 1.39 (95% CI 0.86, 2.25)

Physician prescribed antidepressants to “patient 1” at 6 weeks OR 1.97 (95% CI 0.85, 4.55)

Physician prescribed antidepressants to “patient 2” at 6 weeks OR 1.57 (95% CI 0.89, 2.74)

Physician scheduled follow-up within 2 weeks for “patient 1” at 6 weeks OR 2.23 (95% CI 1.26, 3.97)

Physician scheduled follow-up within 2 weeks for “patient 2” at 6 weeks OR 2.09 (95% CI 1.19, 3.65)

Physician assessed > 5 criteria for major depression in “patient 1” at 6 weeks OR 2.13 (95% CI 1.26, 3.59)

Physician assessed > 5 criteria for major depression in “patient 2” at 6 weeks OR 1.70 (95% CI 0.87, 3.31)

Physician assessed stresses at home in “patient 1” at 6 weeks OR 1.46 (95% CI 1.09, 1.96)

Physician assessed stresses at home in “patient 2” at 6 weeks OR 1.42 (95% CI 0.96, 2.08)

Physician assessed suicidal ideation in “patient 1” at 6 weeks OR 13.00 (95% CI 1.82, 92.92)

Physician assessed suicidal ideation in “patient 2” at 6 weeks OR 1.04 (95% CI 0.39, 2.77)

Patient health outcomes: NR

Goldberg [58]; Horowitz, 1996 [89]

Country: USA

Setting: primary care office

Randomization unit: group practices within primary care clinics

Number of sites: 4

Providers: 95 (allocation to condition reported for 78 providers: academic detailing, 37 academic detailing + CQI team, 23 UC) PCPs

Patients: 4995 (allocation to condition reported for 4051 patients: 1073 academic detailing, 1672 academic detailing + CQI team, 1306 UC) age 18 to 75 making clinic visits between February and July 1994

Diagnosis: depression (clinical diagnosis), depression (rating scale)

Intervention: academic detailing and educational sessions based on clinical practice guidelines from the AHCPR Quick Reference Guide for Clinicians

Comparator: UC, other (two comparators: (1) usual care and (2) academic detailing plus continuous quality improvement teams (complex system redesign))

Timing of follow-up: 12 months

Provider behaviors:

% of eligible known depressives prescribed 1st-generation tricyclics, all clinics at 12 months

--Academic detailing vs AD + CQI, OR 0.93 (95% CI 0.79, 1.10)

--Academic detailing vs usual care, OR 1.12 (95% CI 0.96, 1.30)

% of eligible known depressives prescribed 2nd-generation tricyclics, all clinics at 12 months

--Academic detailing vs AD + CQI, OR 0.92 (95% CI 0.72, 1.17)

--Academic detailing vs usual care, OR 1.05 (95% CI 0.83, 1.34)

% of eligible known depressives prescribed SSRIs, all clinics at 12 months

--Academic detailing vs AD + CQI, OR 1.04 (95% CI 0.95, 1.15)

--Academic detailing vs usual care, OR 1.02 (95% CI 0.93, 1.12)

% of eligible unrecognized depressives prescribed antidepressants, All clinics at 12 months*

--Academic detailing vs AD + CQI, OR 1.01 (95% CI 0.62, 1.64)

--Academic detailing vs usual care, OR 0.94 (95% CI 0.56, 1.59)

Patient health outcomes:

SCL score in known depressives, all clinics at 12 months

--Academic detailing vs AD + CQI, MD − 0.12 (95% CI not calculable)

--Academic detailing vs usual care, MD − 0.09 (95% CI not calculable)

SCL score in known depressives, best-case clinic at 12 months

--Academic detailing vs AD + CQI, MD − 0.27 (95% CI not calculable)

--Academic detailing vs usual care, MD − 0.22 (95% CI not calculable)

Keeley [59]

Country: USA

Setting: primary care clinics at a federally qualified community health care system

Randomization unit: site

Number of sites: 7 (3 motivational interviewing, 4 guideline only)

Providers: 21 (10 motivational interviewing, 11 guideline only) PCPs

Patients: 171 (85 motivational interviewing, 86 guideline only) 18 years and older

Diagnosis: depression (rating scale); PHQ-9 score ≥ 10

Intervention: distribution of practice guideline and recommendations for treatment based on APA’s Practice Guideline for the Treatment of MDD

Comparator: other (guidelines plus motivational interviewing training)

Timing of follow-up: 24 months

Provider behaviors:

Prescription for antidepressant medication at 24 months* OR 0.85 (95% CI 0.43, 1.69)

Provider recommendation for physical activity at 24 months OR 0.45 (95% CI 0.20, 1.01)

Patient health outcomes:

Treatment adherence: days physically active in past week at 24 months MD 1.21 (95% CI 0.37, 2.05)

Treatment adherence: filled prescription at 24 months OR 0.79 (95% CI 0.29, 2.08)

Kurian [60]; Trivedi, 2004 [90]

Country: USA

Setting: primary care office

Randomization unit: provider

Number of sites: 3

Providers: 4 (2 intervention, 2 control) PCPs

Patients: 55 (32 intervention, 23 control) 18 years and older

Diagnosis: MDD, depression (rating scale); ≥ 14 on HDRS-17

Intervention: education plus practice with a computerized support decision system. Guidelines based on APA practice guidelines and consensus expert opinion developed in the Texas Medication Algorithm Project

Comparator: other (UC that included initial 1 h training on guidelines)

Timing of follow-up: 12 weeks

Provider behaviors:

No. of treatment visits at 12 weeks* MD − 1.30 (95% CI − 2.31, − 0.29)

Received an adequate antidepressant dose at 12 weeks* OR 1.05 (95% CI 0.72, 1.54)

Treatment augmentation (algorithm approved) at 12 weeks OR 0.96 (95% CI 0.24, 3.88)

Treatment switch (new antidepressant) at 12 weeks OR 2.52 (95% CI 0.57, 11.02)

Patient health outcomes:

Rate of remission on HDRS (HDRS ≤ 7) at 12 weeks OR 1.13 (95% CI 0.59, 2.15)

Rate of response on HDRS (50% decrease in symptom severity) at 12 weeks OR 0.97 (95% CI 0.63, 1.50)

Rate of response on QIDS-SR (≥ 50% decrease in symptom severity) at 12 weeks

--Computerized decision support system vs usual care (guidelines and training), OR 1.58 (95% CI 0.70, 3.53)

Lin [78]; Katzelnick, 2000 [91]

Country: USA

Setting: primary care office

Randomization unit: provider

Number of sites: 15

Providers: 109 (53 intervention, 56 UC) PCPs

Patients: 124,893 (60,689 intervention, 64,204 UC)

Diagnosis: MDD, other depression diagnosis (dysthymic, adjustment, depression NOS) from the HMOs between ages 18–64 whose ambulatory visits were below the top 15th percentile for the prior 2 consecutive years

Intervention: education with group feedback. Guidelines based on DSM-IV diagnostic criteria

Comparator: UC

Timing of follow-up: 12 months

Provider behaviors:

12 weeks continuous medication at 12 months* OR 0.98 (95% CI 0.81, 1.20)

New antidepressant prescriptions/100 visits at 12 months* IRR 1.07 (95% CI 0.90, 1.26)

Patient health outcomes: NR

Linden [92]

Country: Germany

Setting: psychiatry private practice (specialty care)

Randomization unit: provider

Number of sites: NR

Providers: 103 (20 guidelines plus training, 20 guidelines only, 43 control) mental health care providers

Patients: 497 (100 guidelines plus training, 196 guidelines only, 202 control)

Diagnosis: unclear

Intervention: receipt of depression guideline alone or with training on WHO depression guidelines and detailed recommendations on patient counseling and management

Comparator: UC

Timing of follow-up: 12 weeks

Provider behaviors:

Adverse drug reactions at 12 weeks

--WHO guideline only vs control group, MD − 0.01 (95% CI − 0.04, 0.02)

--WHO guideline + training vs control group, MD − 0.01 (95% CI − 0.04, 0.01)

Prescribed dosages of mirtazapine, mean mg/day at 12 weeks*

--WHO guideline only vs control group, MD − 1.41 (95% CI − 2.87, 0.05)

--WHO guideline + training vs control group, MD − 2.38 (95% CI − 4.07, − 0.69)

Patient health outcomes:

CGI severity at 12 weeks

--WHO guideline only vs control group, MD − 0.07 (95% CI − 0.29, 0.15)

--WHO guideline + training vs control group, MD − 0.31 (95% CI − 0.57, − 0.05)

Patient depression rating at 12 weeks

--WHO guideline only vs control group, MD − 1.13 (95% CI − 2.63, 0.37)

--WHO guideline + training vs control group, MD − 1.53 (95% CI − 3.33, 0.27)

Psychiatrist depression rating at 12 weeks

--WHO guideline only vs control group, MD − 2.27 (95% CI − 4.49, − 0.05)

--WHO guideline + training vs control group, MD − 3.23 (95% CI − 5.89, − 0.57)

Nilsson [93]

Country: Sweden

Setting: continuing medical education groups and health care centers (primary care)

Randomization unit: provider

Number of sites: 6 health care centers and 3 CME groups

Providers: 50 (40 participated: 18 in hypertension group, 8 in peptic ulcer/dyspepsia group, 14 in depression group) other general practitioners or clinicians

Patients: 45,982; description NR

Diagnosis: unclear

Intervention: pharmacotherapy education group. Guidelines based on literature review and recent national and local recommendations on treatment

Comparator: other (delivery of education and feedback regarding non-depression control areas (hypertension and peptic ulcers))

Timing of follow-up: 12 months

Provider behaviors:

Fractional prescribing rate: selective serotonin reuptake inhibitors at 12 months MD − 3.80 (95% CI − 12.96, 5.36)

Fractional prescribing rate: tricyclic antidepressants at 12 months* MD 2.70 (95% CI − 6.08, 11.48)

Prescribed DDDs/1000 patients per year at 12 months* IRR 0.78 (95% CI 0.75, 0.81)

Prescribed DDDs/GP at 12 months IRR 1.00 (95% CI 0.97, 1.03)

Patient health outcomes: NR

Rollman [61]; Rollman, 2002 [94]

Country: USA

Setting: academically affiliated primary care practice

Randomization unit: provider

Number of sites: 1

Providers: 17 (16 enrolled: 6 active care, 5 passive care, 5 usual care) PCPs

Patients: 227 (78 active care, 78 passive care, 71 usual care)

Diagnosis: depression (clinical diagnosis)

Intervention: reminders of patients’ depression diagnosis with or without recommendations from AHRQ’s Depression Panel’s Guideline for the treatment of major depression

Comparator: UC

Timing of follow-up: 6 months

Provider behaviors:

# of contacts with any PCP at 6 months

--EMR—active care vs EMR—usual care, MD − 0.50 (95% CI not calculable)

--EMR—passive care vs EMR—usual care, MD 0.08 (95% CI not calculable)

# of contacts with usual PCP at 6 months¹

--EMR—active care vs EMR—usual care, MD − 0.40 (95% CI not calculable)

--EMR—passive care vs EMR—usual care, MD − 0.09 (95% CI not calculable)

# of office visits with usual PCP at 6 months

--EMR—active care vs EMR—usual care, MD − 0.91 (95% CI not calculable)

--EMR—passive care vs EMR—usual care, MD − 0.69 (95% CI not calculable)

≥ 3 contacts with usual PCP at 6 months

--EMR—active care vs EMR—usual care, OR 1.58 (95% CI 1.12, 2.21)

--EMR—passive care vs EMR—usual care, OR 1.50 (95% CI 1.06, 2.11)

Antidepressant medication not offered at 6 months

--EMR—active care vs EMR—usual care, OR 1.48 (95% CI 0.93, 2.36)

--EMR—passive care vs EMR—usual care, OR 1.45 (95% CI 0.92, 2.29)

Antidepressant meds baseline regimen continued without modification at 6 months

--EMR—active care vs EMR—usual care, OR 2.43 (95% CI 0.68, 8.76)

--EMR—passive care vs EMR—usual care, OR 2.66 (95% CI 0.75, 9.38)

Antidepressant meds suggested/prescribed or baseline regimen modified at 6 months

--EMR—active care vs EMR—usual care, OR 1.14 (95% CI 0.83, 1.56)

--EMR—passive care vs EMR—usual care, OR 1.11 (95% CI 0.81, 1.52)

Depression mentioned in ≥ 3 contacts with usual PCP at 6 months

--EMR—active care vs EMR—usual care, OR 1.74 (95% CI 0.91, 3.31)

--EMR—passive care vs EMR—usual care, OR 1.77 (95% CI 0.94, 3.35)

Depression mentioned in any contact with usual PCP at 6 months*

--EMR—active care vs EMR—usual care, OR 1.07 (95% CI 0.88, 1.29)

--EMR—passive care vs EMR—usual care, OR 1.17 (95% CI 0.99, 1.40)

Depression treatment mentioned in ≥ 3 contacts with usual PCP at 6 months

--EMR—active care vs EMR—usual care, OR 1.33 (95% CI 0.67, 2.63)

--EMR—passive care vs EMR—usual care, OR 1.29 (95% CI 0.65, 2.56)

Mental health referral suggested at 6 months

--EMR—active care vs EMR—usual care, OR 0.75 (95% CI 0.44, 1.25)

--EMR—passive care vs EMR—usual care, OR 1.01 (95% CI 0.64, 1.59)

PCP counsels patient for depression at 6 months

--EMR—active care vs EMR—usual care, OR 1.19 (95% CI 0.63, 2.25)

--EMR—passive care vs EMR—usual care, OR 0.95 (95% CI 0.49, 1.87)

Patient health outcomes:

HRS-D score at 3 months

--EMR—active care vs EMR—usual care, MD − 1.50 (95% CI not calculable)

--EMR—passive care vs EMR—usual care, MD 0.50 (95% CI not calculable)

HRS-D score at 6 months

--EMR—active care vs EMR—usual care, MD − 1.50 (95% CI not calculable)

--EMR—Passive care vs EMR—usual care, MD − 1.50 (95% CI not calculable)

Recovery rate (HRS-D ≤ 7) at 6 months

--EMR—active care vs EMR—usual care, OR 0.98 (95% CI 0.50, 1.91)

--EMR—passive care vs EMR—usual care, OR 1.05 (95% CI 0.55, 2.00)

Shirazi [63]; Shirazi, 2009 [95]

Country: Iran

Setting: primary care office

Randomization unit: provider

Number of sites: NR

Providers: 192 (96 intervention, 96 control) PCPs

Patients: 10 SPs

Diagnosis: other depression diagnosis (SPs with depressive symptoms)

Intervention: continuing medical education course tailored toward self-reported stage of change. Guidelines generated by researchers based on literature review

Comparator: other (guidelines and education without tailoring to stage of change)

Timing of follow-up: 2 months

Provider behaviors:

Performance score on appropriate treatment (prescription, lab tests, referrals) at 2 months*

--Intervention—large group vs control—large group, MD − 24.00 (95% CI − 44.08, − 3.92)

--Intervention—small group vs control—small group, MD − 36.00 (95% CI − 46.76, − 25.24)

--Tailored education vs ceducation, MD − 27.00 (95% CI − 35.60, − 18.40)

Patient health outcomes: NR

Simon [52]

Country: USA

Setting: primary care office

Randomization unit: patient

Number of sites: 5

Providers: number NR; PCPs

Number of patients: 613 patients at participating five primary care clinics who had received new prescriptions for antidepressants, with “new” defined as no antidepressant use in the previous 120 days

Diagnosis: depression (clinical diagnosis)

Intervention: receipt of detailed patient report and treatment recommendations based on a computerized algorithm. Guidelines not specified

Main dichotomous outcome: patients who receive adequate pharmacotherapy (low dose, > 90 days)

Comparator: UC, other (feedback intervention plus care management)

Timing of follow-up: 6 months

Provider behaviors:

Mental health visits to non-prescribing provider at 6 months

--Feedback only vs feedback plus care management, MD − 0.10 (95% CI − 0.93, 0.73)

--Feedback only vs usual care, MD 0.22 (95% CI − 1.11, 1.55)

Mental health visits to prescribing provider at 6 months*

--Feedback only vs feedback plus care management, MD − 0.04 (95% CI − 0.48, 0.40)

--Feedback only vs usual care, MD − 0.01 (95% CI − 0.49, 0.47)

Patients who receive adequate pharmacotherapy (low dose, > 90 days) at 6 months*

--Feedback only vs feedback plus care management, OR 0.91 (95% CI 0.74, 1.13)

--Feedback only vs usual care, OR 1.10 (95% CI 0.87, 1.39)

Patients who receive adequate pharmacotherapy (moderate dose, > 90 days) at 6 months

--Feedback only vs feedback plus care management, OR 0.70 (95% CI 0.50, 0.98)

--Feedback only vs usual care, OR 1.17 (95% CI 0.79, 1.73)

Patient health outcomes:

Depression score at 6 months

--Feedback only vs feedback plus care management, MD 0.14 (95% CI not calculable)

--Feedback only vs usual care, MD − 0.01 (95% CI not calculable)

Major depression by DSM-IV at 6 months

--Feedback only vs feedback plus care management, OR 0.53 (95% CI 0.30, 0.94)

--Feedback only vs usual care, OR 1.00 (95% CI 0.63, 1.58)

Probability of showing 50% decrease in depression score at 6 months

--Feedback only vs feedback plus care management, OR 0.79 (95% CI 0.65, 0.95)

--Feedback only vs usual care, OR 1.10 (95% CI 0.88, 1.38)

Sinnema [51]

Country: Netherlands

Setting: general practices (solo practices, group practices or health centers) (primary care)

Randomization unit: site

Number of sites: 23 (12 intervention, 11 control)

Providers: 46 (23 intervention, 23 control) PCPs

Patients: 444 (198 intervention, 246 control) 18 years or older attending participating practices

Diagnosis: depression (rating scale); screen positive (≥ 20) on Extended Kessler 10 screening instrument

Intervention: training and consultations from experts with incorporation of personal barriers to guideline implementation on the Dutch College of General Practitioner’s guidelines for depression and anxiety

Comparator: other (1-day training from experts on implementing guidelines but no tailored intervention on barriers)

Timing of follow-up: 6 months

Provider behaviors:

Number of consultations at 6 months* IRR 1.78 (95% CI 1.14, 2.78)

Prescribing antidepressants at 6 months* OR 1.07 (95% CI 0.52, 2.19)

Referral to specialist mental health services at 6 months OR 1.62 (95% CI 0.72, 3.64)

Patient health outcomes:

4DSQ depression at 6 months MD 0.06 (95% CI − 0.52, 0.64)

WHODAS II at 6 months MD 1.02 (95% CI − 2.08, 4.12)

van Eijk [65]

Country: Netherlands

Setting: GPs and pharmacists in peer review groups (primary care)

Randomization unit: site

Number of sites: 21 (7 individual intervention, 7 group intervention, 7 control)

Providers: 122 (70 GPs and 14 pharmacists in individual intervention, 52 GPs and 9 pharmacists in group intervention, 68 GPs and 13 pharmacists in control)

Number of patients: 46,078 people aged 60 years old or over on 1 January 1996 (about 50,000 people) living in the southwest Netherlands health district and insured

Diagnosis: unclear

Intervention: group-based on individual-based academic detailing session and review of group- or individual-based performance. Guidelines not specified

Comparator: UC

Timing of follow-up: 4 months

Provider behaviors:

Rate of incident prescriptions of less anticholinergic antidepressants after intervention at 4 months*

--Group educational visits vs control group, IRR 1.66 (95% CI 0.97, 2.85)

--Individual educational visits vs control group, IRR 2.02 (95% CI 1.24, 3.30)

Rate of incident prescriptions of highly anticholinergic antidepressants after intervention: prescriptions/1000 patient years at 4 months

--Group educational visits vs control group, IRR 1.79 (95% CI 0.87, 3.57)

--Individual educational visits vs control group, IRR 1.47 (95% CI 0.85, 2.56)

Patient health outcomes: NR

Worrall [62]

Country: Canada

Setting: family practice research networks (primary care)

Randomization unit: provider

Number of sites: NR

Number of providers: 42 PCPs

Number of patients: 147, description NR

Diagnosis: depression (rating scale)

Intervention: workshop on clinical practice guidelines with follow-up consultations. Guidelines based on Canadian Medical Association’s CPGs

Comparator: other (receipt of clinical practice guidelines without education)

Timing of follow-up: 6 months

Provider behaviors:

Mean no. of office visits per patient at 6 months* MD 0.60 (95% CI − 1.94, 3.14)

No. of patients prescribed an antidepressant on first visit at 6 months* OR 1.02 (95% CI 0.91, 1.14)

No. of referrals to other mental health professional at 6 months OR 10.53 (95% CI 0.62, 179.01)

No. of referrals to psychiatrist at 6 months OR 1.85 (95% CI 0.39, 8.83)

Patient health outcomes:

CES-D score—patient at 6 months MD 2.80 (95% CI − 1.35, 6.95)

CES-D score gain—patient at 6 months MD − 3.80 (95% CI − 8.70, 1.10)

No. of patients taking medication at 6-month follow-up at 6 months OR 1.43 (95% CI 0.98, 2.07)

No. of patients who took antidepressant for full 6 months at 6 months OR 1.23 (95% CI 0.82, 1.84)

Yawn [64]

Country: USA

Setting: family medicine research network practices (primary care)

Randomization unit: site

Number of sites: 28 (14 intervention, 14 control)

Providers: NR (teams)

Number of patients: 2343 (1353 intervention, 990 control) women aged at least 18 years, were 5 to 12 weeks’ postpartum

Diagnosis: depression (rating scale)

Intervention: education and a set of tools for postpartum depression. Guidelines not specified

Comparator: UC

Timing of follow-up: 12 months

Provider behaviors:

Medication plus counseling at 12 months OR 1.62 (95% CI 1.32, 2.00)

Received 2nd call after successful 1st call (women diagnosed with depression) at 12 months* OR 103.48 (95% CI 6.43, 1665.63)

Received counseling at 12 months OR 1.82 (95% CI 1.13, 2.93)

Treatment with medication at 12 months OR 1.60 (95% CI 1.28, 1.98)

Patient health outcomes:

Improved PHQ-9, if history of depression at 12 months OR 1.24 (95% CI 0.86, 1.79)

Improved PHQ-9, if postpartum depression was diagnosed at 12 months OR 1.10 (95% CI 0.77, 1.56)