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Cover  |  Preface  |  Knowledge Objectives  |  Table of Contents  |  Overview


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 care managers implement these innovations. Primary care clinicians have a related workshop. It is most useful if care managers attend the primary care clinicians’ workshop as well as their own. Both workshops cover specific innovations that 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 among the primary care clinician, a Care Manager, and mental health professionals designed to assist the patient.

The care manager workshop continues a process of change that will enable primary care practices to implement these innovations. 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 primary care practice, and in collaborating with a supervising psychiatrist.

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