Mental Health

New program helps local managed care practices improve depression care provided by primary care doctors

Depression affects one in ten Americans every year, and half of these patients are cared for by primary care physicians (PCPs). However, PCPs have a poor record of diagnosing and appropriately treating depression, despite the presence of national depression care guidelines. Once symptoms are detected by the PCP, patients require at least 30 minutes of initial assessment and education followed by active treatment and monitoring for up to 1 year. These are daunting tasks for PCPs, whose typical appointment slot is 15 minutes. Also, mental health specialists are less integrated into primary care practices than medical specialists, so PCPs often must struggle with difficult cases on their own.

However, a recent study of 46 primary care clinics in network or staff-model health maintenance organizations shows that local managed care practices can successfully implement an expert-designed collaborative care program to improve depression care by primary care doctors. The Partners in Care program involves a team-based approach that enhances the practice's capacity for patient assessment, education, and treatment-monitoring for depression through use of nurse depression specialists and provides mechanisms for improved primary care/mental health specialty partnerships. Partners in Care is the Patient Outcomes Research Team (PORT) project on improving the cost-effectiveness of care for depression in managed primary care. The project is supported by the Agency for Healthcare Research and Quality (HS08349) and led by Kenneth B. Wells, M.D., M.P.H., of the RAND Corporation and the UCLA Neuropsychiatric Institute.

This study found that when the clinical leaders of local managed care practices were trained in multimodal quality improvement programs, practices achieved above 70 percent adherence rates for most intervention components. For example, they were near 100 percent for hiring depression nurse specialists and reducing copayments for psychotherapy. Adherence rates were lower in some areas, however. For example, only 55 percent of patients on antidepressants were followed by nurses to monitor symptoms, side effects, and medication compliance for the full expected duration (6 or 12 months).

Details are in "Evidence-based care for depression in managed primary care practices," by Lisa V. Rubenstein, M.D., M.S.N.S., Maga Jackson-Triche, M.D., M.P.H., Jurgen Unutzer, M.D., M.P.H., and others, in the September 1999 Health Affairs 18(5), pp. 89-105.

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