| The process of care for detecting and managing depressive disorders in primary care can be divided into steps. These steps are listed below and described in more detail in the following pages. |
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Steps involving the care manager are in BOLD and marked with a 
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| 1. |
Recognition and Diagnosis |
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“Flags” for depression |
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Two question screen |
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PHQ-9 for depression diagnosis/severity |
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Suicide risk |
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Other pertinent diagnostic assessments |
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Formulate and explain diagnosis
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| 2. |
Treatment Selection |
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Additional history including previous treatment, co-morbidity |
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Explain treatment options |
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Elicit patient treatment preferences
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| 3. |
Initial Acute Phase Treatment |
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Patient engagement |
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Provide key educational messages |
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Set self-management goals |
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Explain and recommend care management |
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Set time for first care management call
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| 4. |
Care Management Process |
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Initial call(s) to monitor treatment initiation / adherence |
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Mail written educational materials (Unless PCC has provided) |
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Follow-up calls using PHQ-9 to assess treatment response |
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Care management supervision with psychiatrist |
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Communication with clinician
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| 5. |
Acute Phase Follow-Up |
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Care management contacts coordinated with PCC office visits |
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Evaluate patient response to treatment with a goal of remission |
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Modifying treatment when sub-optimal response |
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Strive for remission
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| 6. |
Continuation & Maintenance Phase Care |
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Continue treatment response monitoring after remission |
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Administer maintenance dysthymia questionnaire |
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Discuss risk factors / need for long-term prophylactic treatment during care management supervision |
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Continue counseling and/or antidepressant treatment for 4-9 months to prevent relapse |
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Continue long-term prophylactic treatment and monitoring for at risk patients |
