Achieving guidelines for the treatment of depression in primary care: is physician education enough?

Med Care. 1997 Aug;35(8):831-42. doi: 10.1097/00005650-199708000-00008.


Objectives: The authors examine whether physician education has enduring effects on treatment of depression.

Methods: Depressed primary care patients initiating antidepressant treatment from primary care clinics of a staff-model health maintenance organization were studied. Quasi-experimental and before-and-after comparisons of physician practices, supplemented with patient surveys, were used to compare the process of care and depression outcomes. Intervention consisted of extensive physician education that spanned a 12-month period. This included case-by-case consultations, didactics, academic detailing (eg, clearly stating the educational and behavioral objectives to individual physicians), and role-play of optimal treatment. Main outcome measures were divided into two groups. Quasi-experimental samples included: (1) antidepressant medication selection and (2) adequacy (dosage and duration) of pharmacotherapy. Survey samples included: (3) intensity of follow-up; (4) physician delivered educational messages regarding depression treatment; (5) patient satisfaction; and (6) depression outcomes.

Results: No lasting educational effect was observed consistently in any of the outcomes measured.

Conclusions: There was no enduring improvement in the treatment of depression for primary care patients. Depression treatment guidelines were achieved contemporaneously, however, for intervention patients enrolled in a multifaceted program of collaborative care during the training period. These results suggest that continuing programs of reorganized service delivery to support the role of a primary care physician (eg, on-site mental health personnel, close monitoring of patient progress and adherence), in addition to physician training, are essential for the success of guideline implementation.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Depressive Disorder / drug therapy*
  • Drug Monitoring / standards
  • Education, Medical, Continuing / organization & administration*
  • Health Maintenance Organizations
  • Humans
  • Logistic Models
  • Middle Aged
  • Outcome and Process Assessment, Health Care
  • Patient Education as Topic / standards
  • Patient Satisfaction
  • Physicians, Family / education*
  • Practice Guidelines as Topic / standards*
  • Primary Health Care / standards*
  • Program Evaluation
  • Washington