Depression is a common disorder in primary care settings. Primary care physicians (PCPs) can play an important role in the management of depression. Unfortunately, the care provided by PCPs is frequently less than adequate. In order to improve the treatment and outcomes of depressed primary care patients we have convened a panel of nationally recognized mental health experts to participate in the development of a depression management model for PCPs. The model will be refined further after review by additional mental health investigators and PCPs. Once the development of the model has been completed we will evaluate two interventions designed to facilitate the implementation of this model. The first intervention (education) uses an office-based tutorial, an educational manual and depression management tools to train and encourage physicians to use the model. The second intervention (feedback) provides PCPs with information related to the identification and assessment stages of the model before the medical visit, as well as information about patients' perceptions of their mental health care and mental health problem following the visit. These interventions will be tested in the offices of 100 primary care physicians who will be recruited by U.S. Healthcare, an IPA model HMO with over 1 million members. Twenty-five PCPs will receive the educational intervention; 25 will receive the feedback intervention; 25 will receive both education and feedback; and 25 PCPs will serve as a control group. A total of 800 patients will be included in the study. Study outcomes will determine whether the 2 interventions lead to: 1) reduced symptoms of depression; 2) improved function and well-being; 3) reduced health care utilization and cost; and 4) more favorable physician attitudes about managing patients with psychosocial problems. We will also determine whether the experimental interventions effect the care or outcomes of HMO patients differently than fee-for-service patients. If the experimental interventions are shown to be effective, we plan to evaluate strategies to disseminate these interventions to all of U.S. Healthcare's primary care offices and assess their impact in this larger population. In addition, we will determine whether exposure to feedback trains physicians to collect this information on their own and leads to enduring improvement in PCPs' abilities to identify and assess depression.
| Brody, D S; Hahn, S R; Spitzer, R L et al. (1998) Identifying patients with depression in the primary care setting: a more efficient method. Arch Intern Med 158:2469-75 |
| Brody, D S; Khaliq, A A; Thompson 2nd, T L (1997) Patients' perspectives on the management of emotional distress in primary care settings. J Gen Intern Med 12:403-6 |
