An Effective Intervention for Managing Depression in Primary Care

The inadequate treatment of depression in primary care settings continues to be a major public health problem despite efforts to improve care. “In primary care, most depressed patients have chronic or recurrent depression,” explains Michael S. Klinkman, MD, MS, “and many cases are further complicated by comorbid health disorders. Treatment protocols that are designed to improve the effectiveness of acute-phase care apply only to a small fraction of the depressed patients that are seen by primary care physicians [PCPs].” The DPC Intervention Dr. Klinkman and colleagues at the University of Michigan had a study published in the September/October 2010 Annals of Family Medicine in which the Depression in Primary Care (DPC) intervention was assessed. “The primary aim of the DPC project was to develop, implement, and evaluate the effectiveness and sustainability of a depression management program that could support how PCPs manage patients in both acute and chronic phases of treatment,” says Dr. Klinkman. The DPC clinical intervention included several components, including care managers who offered support at specific sites, disease monitoring and clinician feedback, patient activation and self-management assistance, and a clinical information system in which a secure email system enabled care managers, PCPs, and consultation-liaison psychiatrists to communicate efficiently to coordinate care. The DPC intervention consisted of a series of telephone calls and email exchanges between enrollees and care managers, care managers and referring physicians, and, on occasion, care managers and consultation-liaison psychiatrists (Table 1). Dr. Klinkman says “the primary goals were to increase enrollees’ self-management of depression and provide feedback to referring physicians about clinical progress and possible complications in treatment.” The intake telephone call, which required 20 to...