Application of a depression management office system in community practice: a demonstration

J Am Board Fam Pract. Mar-Apr 2003;16(2):107-14. doi: 10.3122/jabfm.16.2.107.

Abstract

Background: Recent studies provide new insights about strategies that improve depression outcomes. We explored the feasibility of implementing these strategies in community practices.

Methods: Clinicians followed an office system approach to management of depression. There were no controls. The office system was based on established routines performed by a primary care clinician working in a prepared practice, a telephone care manager, and a collaborating psychiatrist, all using a common severity monitoring tool. Five practices with 18 clinicians participated. Sixty-six adult patients had depression diagnosed, and 60 (91%) received care according to the model through 8 weeks of follow-up visits. Depression outcomes were assessed using PHQ-9.

Results: At baseline, 48 (80%) patients met criteria for major depressive disorder, chronic depression, or both, while others had less severe symptoms. Of 32 patients with moderately severe or severe depression, the 8-week follow-up severity score decreased by > or = 50% for 23 (70%). Of patient barriers to adherence, ambivalence about treatment and medication side effects were most common. Most patients received three care manager telephone calls requiring 6 to 10 minutes each.

Conclusion: Application of the office system was feasible in this demonstration project. If results are confirmed in further studies, this approach will be appropriate for widespread application.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Depression / diagnosis*
  • Depression / economics
  • Depression / therapy*
  • Depressive Disorder / diagnosis*
  • Depressive Disorder / economics
  • Depressive Disorder / therapy*
  • Family Practice / methods*
  • Feasibility Studies
  • Female
  • Health Services Accessibility
  • Humans
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care
  • Patient Care Team
  • Patient Compliance
  • Primary Health Care / methods*
  • Program Development
  • Program Evaluation
  • Psychiatric Status Rating Scales
  • Telephone
  • United States