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Primary Care Not Well Equipped to Manage Depression


Depression requires the same time and attention given to other chronic diseases, but few primary care practices are equipped to deliver.

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Primary care physicians play an important role in the diagnosis and management of depression. More than half of the care visits for depression in the US are conducted in primary care doctors’ offices, yet little is known about their use of care management processes for the disorder, according to the researchers, led by Dr. Tara F. Bishop, associate professor in the Department of Healthcare Policy and Research at Weill Cornell Medical College, in New York.

Using national survey data for the period of 2006 to 2013, the researchers assessed the use of five care management processes for depression and other chronic illnesses among more than 1,000 primary care practices in the United States:  

 â–º Employing nurse care managers

 â–º Keeping a registry of all patients with a condition that requires regular follow-up

 â–º Reminding patients to comply with their treatment regimens

 â–º Teaching them about their illnesses

 â–º Giving doctors feedback

“We found significantly less use for depression than for asthma, congestive heart failure, or diabetes in 2012–13. On average, practices used fewer than one care management process for depression, and this level of use has not changed since 2006–07, regardless of practice size,” the researchers state.

About one-third of the practices kept registries of depressed patients, and the other steps were less commonly used. Less than 10 percent reminded patients about their treatments or taught them about the condition.

In contrast, they found the use of diabetes care management processes has increased significantly among larger practices.

Many primary care physicians face challenges when treating depression, such as limited time during appointments and inadequate access to resources, the study’s authors noted.

Also, successful treatments for depression can be more elusive than for other chronic diseases. For example, primary care physicians can prescribe antidepressants, but there are other forms of treatment, including talk and behavioral therapies, that might be very effective, but are difficult to deliver in the primary care setting.

“Shortages and limitations of access to psychiatrists,” the authors state, are also a reality for many patients. Patients may have difficulty locating nearby psychiatrists or those who accept their insurance plans. Patients may also avoid seeking out a mental health specialist because of the perceived stigma associated with such contact.

In addition, primary care physicians can easily tracking patients’ progress with chronic physical illnesses, such as monitoring a patient’s blood pressure or A1c score at each visit. There are tools to help track depression, such as the Patient Health Questionnaire (PHQ-9), a brief survey that allows a physician to track a patient’s depression from visit to visit.

In conclusion, the researchers state “these findings may indicate that US primary care practices are not well equipped to manage depression as a chronic illness, despite the high proportion of depression care they provide. Policies that incentivize depression care management, including additional quality metrics, should be considered.”


Bishop TF, Ramsay PP, Casalino LP, et al. Care management processes used less often for depression than for other chronic conditions in US primary care practice. Health Aff . 2016;  35:394-400. doi: 10.1377/hlthaff.2015.1068


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