Implementation of Guideline-Based Care for Depression in Primary Care (original) (raw)

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Translating Evidence-Based Depression Management Services to Community-Based Primary Care Practices

Milbank Quarterly, 2004

Randomized controlled trials have demonstrated the efficacy and costeffectiveness of using treatment models for major depression in primary care settings. Nonetheless, translating these models into enduring changes in routine primary care has proved difficult. Various health system and organizational barriers prevent the integration of these models into primary care settings. This article discusses barriers to introducing and sustaining evidence-based depression management services in community-based primary care practices and suggests organizational and financial solutions based on the Robert Wood Johnson Foundation Depression in Primary Care Program. It focuses on strategies to improve depression care in medical settings based on adaptations of the chronic care model and discusses the challenges of implementing evidence-based depression care given the structural, financial, and cultural separation between mental health and general medical care. Key Words: Patient care management, delivery of health care, integrated quality of care, depressive disorder, depression. S uccessive generations of behavioral health services research have consistently demonstrated that major depression experienced by adult patients can be effectively treated in

Evidence-based care for depression in managed primary care practices

Health Affairs, 1999

PROLOGUE: The gap between theory and practice in health care can be daunting. Researchers armed with massive amounts of outcomes data face the problem of translating their findings into workable interventions in the practice setting. This paper reports on an attempt to bridge the gap, taking advantage of the administrative capabilities of managed care organizations. The authors designed, implemented, and tracked a collaborative-care program of treatment for patients with symptoms of depression. The results presented here highlight the program's success in creating a "partnership between health care organizations and researchers." Lisa Rubenstein is a practicing geriatrician and internist at the University of California, Los Angeles (UCLA), School of Medicine and Veterans Administration Medical Center (VAMC), Sepulveda, California; a senior natural scientist at RAND; and director of the VA/RAND/UCLA Center for the Study of Healthcare Provider Behavior. Maga Jackson-Triche is director of the Psychiatry Consultation and Liaison Services at the Sepulveda VAMC, and the psychiatric administrator for the PACE (Primary Care and Education) program there. Jürgen Unützer is a geriatric psychiatrist and health services researcher at the UCLA Neuropsychiatric Institute (NPI). Jeanne Miranda, a psychologist, is an associate professor of psychiatry at Georgetown University Medical Center in Washington, D.C. Katy Minnium is a research associate in the department of psychiatry at UCLA. Marjorie Pearson is a health policy analyst at RAND. Ken Wells is professor-in-residence of psychiatry and biobehavioral sciences at UCLA-NPI and a senior scientist at RAND.

Clinic-Level Process of Care for Depression in Primary Care Settings

Administration and Policy in Mental Health and Mental Health Services Research, 2009

Multi-component models for improving depression care target primary care (PC) clinics, yet few studies document usual clinic-level care. This case comparison assessed usual processes for depression management at 10 PC clinics. Although general similarities existed across sites, clinics varied on specific processes, barriers, and adherence to practice guidelines. Screening for depression conformed to guidelines. Processes for assessment, diagnosis, treatment, and follow-up varied to different degrees in different clinics. This individuality of usual care should be defined prior to quality improvement interventions, and may provide insights for introducing or tailoring changes, as well as improving interpretation of evaluation results.

Challenges of implementing depression care managements in the primary care setting

2006

Empirical evidence shows that care management is an effective tool for improving depression treatment in primary care patients. However, several conceptual and practical issues have not been sufficiently addressed. This article explores questions concerning the scope of care management services within the chronic illness care model; optimal ways to identify depressed patients in the primary care setting; responsibilities and desirable qualifications of depression care managers; the location and manner in which care managers interact with patients; costs of services provided by care managers; and the level of supervision by mental health specialists that is necessary to ensure quality care. KEY WORDS: care management; depression; primary care. BACKGROUND Although evidence-based guidelines for the treatment of depression in primary care were pub-lished as early as 1993 by the Agency for Health Care Policy and Research, depression continues to be underdiagnosed and inadequately treated...

Improving depression outcomes in community primary care practice

Journal of General Internal Medicine, 2001

OBJECTIVE: To determine whether redefining primary care team roles would improve outcomes for patients beginning a new treatment episode for major depression. DESIGN: Following stratification, 6 of 12 practices were randomly assigned to the intervention condition. Intervention effectiveness was evaluated by patient reports of 6-month change in 100-point depression symptom and functional status scales.

Depression in primary health care: from evidence to policy

The Medical journal of Australia, 2008

To consider the implications for mental health policy of a recent synthesis of the literature on the effectiveness of different service delivery models for depression in primary care. A discussion based on the results of several systematic reviews of primary care models for depression management. Primary care was defined broadly within a prevention, early-intervention, treatment and recovery/support framework, and incorporated both community and general practice settings. There were promising effective models for depression interventions both in the broader community and in general practice settings. There is a need to support evidence-based models for depression care, including innovative new technologies for facilitating consumer self-management of depression. The ability of practitioner training and guideline implementation to improve consumer outcomes for depression is limited. Policies and incentives are required to facilitate the reorganisation of general practice and, in part...

Challenges of Implementing Depression Care Management in the Primary Care Setting

Administration and Policy in Mental Health, 2006

Empirical evidence shows that care management is an effective tool for improving depression treatment in primary care patients. However, several conceptual and practical issues have not been sufficiently addressed. This article explores questions concerning the scope of care management services within the chronic illness care model; optimal ways to identify depressed patients in the primary care setting; responsibilities and desirable qualifications of depression care managers; the location and manner in which care managers interact with patients; costs of services provided by care managers; and the level of supervision by mental health specialists that is necessary to ensure quality care.

Depression in primary care: linking clinical and systems strategies

General Hospital Psychiatry, 2001

Depression is a serious, often chronic disease that can be managed effectively with a chronic care model in primary care settings. Depressed persons are likely to be seen by a primary care physician, but their condition often goes unrecognized and untreated. There are effective treatment models that consist of efficacious psychotherapeutic and pharmacological interventions, use of evidence-based guidelines for primary care treatment of depression, development of explicit plans and protocols, reorganization of practice, longitudinal follow-up, patient self-management, decision-making support, access to community resources and leadership commitment. Moving these models into everyday practice requires overcoming both clinical and system barriers. Barriers consist of issues surrounding patients, providers, practices, plans, and purchasers. An understanding of these barriers at each level helps to provide a framework for the changes required to overcome them. The Robert Wood Johnson Foundation National Program on Depression in Primary Care will seek to apply simultaneously both clinical and system strategies in a new five-year initiative to overcome these barriers.