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CLINICIAN PARTICIPANT MANUAL Download Manual
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Cover  |  Preface  |  Table of Contents  |  Agenda  |  Workshop Objectives  |  Step 1. - Recognition & Diagnosis


PREFACE


A variety of epidemiological studies have demonstrated the high prevalence of depressive disorders in primary care.1-5 Over half of all depression is treated in primary care practices. Despite many barriers, primary care clinicians do a good job at managing depression. Primary care clinicians place a high priority on recognizing and treating their patients who are suffering from depression 6, but the obstacles to optimal care are formidable. Excellent care for chronic diseases such as depression is more achievable when there is a well-developed system for care.7 Rigorous scientific studies 8-12 have recently identified several innovations that form the basis of a system to help primary care clinicians overcome many of these obstacles and enhance the care they provide.

In 1993, the Depression Guideline Panel of the Agency for Health Care Policy and Research published recommendations for treating depression in primary care practice. 13 These recommendations were based primarily on studies conducted in the specialty mental health setting. Subsequently, Schulberg et al 14 reviewed the literature of randomized controlled trials in primary care. They determined that both antidepressant pharmacotherapy and brief psychotherapies were efficacious when transferred from mental health to primary care settings. However, traditional dissemination strategies were unsuccessful at transferring depression therapies in standard primary care practices. Research has also suggested that successful transfer requires enabling and reinforcing strategies such as reorganization of practice structures to include systematic follow-up assessment and improved access to mental health specialists.

This workshop is designed to help primary care clinicians implement these innovations. The specific innovations lead to a systematic approach to depression management that includes:

•   An easy to use combined depression diagnostic and severity instrument-the PHQ-9; 15

•    Telephone care management support to promote patient adherence to the management plan;

•    A strategy for monitoring the response to treatment and modification of the plan, if indicated, to achieve an adequate response; and

•    A partnership, to assist the patient, among the primary care clinician, a Care Manager, and mental health specialists

This workshop begins a process of change that will enable participants to implement these innovations. The stage for this implementation has already been set by developing the telephone care management resources in your area as well as the interface needed for a partnership among primary care clinicians, a Care Manager, and mental health specialists to assist patients. In this workshop we will describe the enhanced process of depression care and provide training in use of the PHQ-9, in working with a Care Manager, and in collaborating with mental health specialists in your area.

This manual is intended to provide helpful and informative material for clinicians on the subject of depression. This manual is not intended to provide medical advice to patients. The information provided here is general, and is not intended as clinical advice for or about specific patients. Before applying any of this information or drawing any inferences from it, clinicians should verify accuracy and applicability of the information. Any management steps taken with patients should include a discussion of risks and benefits as well as patient preferences.

3CM™, LLC; DARTMOUTH COLLEGE; DUKE UNIVERSITY; DUKE UNIVERSITY HEALTH SYSTEM, INC; PRIVATE DIAGNOSTIC CLINIC, PLLC; THE JOHN D. AND CATHERINE T. MACARTHUR FOUNDATION; ANY PARTICIPANT IN THE INITIATIVE ON DEPRESSION AND PRIMARY CARE; AND CONTRIBUTORS OF INFORMATION TO THIS WEBSITE MAKE NO WARRANTY, EITHER EXPRESS OR IMPLIED, REGARDING THE COMPLETENESS, ACCURACY, OR CURRENCY OF THIS INFORMATION NOR ITS SUITABILITY FOR ANY PARTICULAR PURPOSE.

By accessing the information in this manual, you agree that 3CM™, LLC; Dartmouth College; Duke University; Duke University Health System, Inc.; Private Diagnostic Clinic, PLLC; the John D. and Catherine T. MacArthur Foundation; any participant in the Initiative on Depression and Primary Care; and the contributors of information to this manual shall not be liable to you for any damages, losses or injury caused by the use of any information on this manual or its references/citations.

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