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. 2006 Mar 24;12(1):54–63. doi: 10.1002/mpr.142

Emerging models of depression care: multi‐level (‘6 P’) strategies

Harold Alan Pincus 1, Lin Hough 2,✉, Jeanie Knox Houtsinger 3, Bruce L Rollman 4, Richard G Frank 5
PMCID: PMC6878316  PMID: 12830310

Abstract

Depression is a prevalent, often chronic condition that has enormous personal, social, and financial consequences. Although technologies for treating depression have advanced notably over the past 20 years, many people continue to suffer needlessly, due in part to the lack of evidence‐based treatment applied in primary care settings. Substantial public and private efforts have been devoted to encouraging individuals to seek care, improving recognition and diagnosis by primary care physicians, and implementing evidence‐based treatment practices. From these efforts have come new models of care as well as an awareness of the critical barriers impeding clinical, organizational, economic, and policy implementation of effective care strategies. In this paper, we describe these clinical and systems barriers and consider the perspectives of various stakeholder groups; present emerging clinical models for providing evidence‐based care as well as economic strategies for overcoming barriers to their implementation; and propose community‐based approaches that will need to be tested. To achieve maximum benefits from current knowledge, we will need to implement a multi‐level strategy employing focused efforts involving patients, providers, practice settings, health plans, purchasers (public and private), and populations (or communities): the ‘6 P’ strategy. Copyright © 2003 Whurr Publishers Ltd.

Keywords: depression, chronic disease, primary care, healthcare delivery

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References

  1. American Psychiatric Association . Diagnostic and Statistical Manual of Mental Disorders. Washington DC: American Psychiatric Association, 2000. [Google Scholar]
  2. Bartels SJCE, Oxman TE, Constantino G, et al. Suicidal and death ideation in older primary care patients with depression, anxiety, and at‐risk alcohol use. American Journal of Geriatric Psychiatry 2002; 10(4): 417–27. [PubMed] [Google Scholar]
  3. Brach C, Sanches L, Young D, et al. Wrestling with typology: penetrating the ‘black box’ of managed care by focusing on health care system characteristics. Medical Care Research and Review, 2000; 57(Suppl 2): 93–115. [DOI] [PubMed] [Google Scholar]
  4. Cole SM, Raju M, Barrett J, et al. The MacArthur foundation depression education program for primary care physicians: background participant's workbook, and facilitator's guide. General Hospital Psychiatry 2000; 22(5): p. 299–358. [DOI] [PubMed] [Google Scholar]
  5. DeGruy FV, Pincus HA. The DSM‐IV‐PC: A manual for diagnosing mental disorders in the primary care setting. Journal of the American Board of Family Practice 1996; 9(4): 274–81. [PubMed] [Google Scholar]
  6. Dietrich AJ. Depression management programs. Archives of Family Medicine 2000; 9: 689–90. [DOI] [PubMed] [Google Scholar]
  7. Hunkeler EM, Meresman J, Hargreaves WA, et al., Efficacy of nurse telehealth care and peer support in augmenting treatment of depression in primary care. Archives of Family Medicine 2000; 9: 700–8. [DOI] [PubMed] [Google Scholar]
  8. Katon WJ, Robinson P, VonKorff M, et al. A multifaceted intervention to improve treatment of depression in primary care. Archives of General Psychiatry 1996; 53: 924–32. [DOI] [PubMed] [Google Scholar]
  9. Katzelnick D.J. Antidepressant medication management and health plan employer data information set (HEDIS) criteria: reasons for nonadherence. Journal of Clinical Psychiatry 2002: 63: 727–32. [DOI] [PubMed] [Google Scholar]
  10. Kessler RC. ICPE Surveys. Presented at the Global Research in Anxiety and Depression Network Manic Depressives Disorders Consensus Conference, Martha's Vineyard MA, May 2002.
  11. Kirmayer LJ, Robbins JM, Dworkind M, et al. Somatization and the recognition of depression and anxiety in primary care. American Journal of Psychiatry, 1993. 150(5): 734–41. [DOI] [PubMed] [Google Scholar]
  12. Klinkman MS. Competing demands in psychosocial care. A model for the identification and treatment of depressive disorders in primary care. General Hospital Psychiatry 1997; 19(2): p. 98‐111. [DOI] [PubMed] [Google Scholar]
  13. Kroenke K, Taylor‐Vaisey A, Dietrich AJ, et al. Interventions to improve provider diagnosis and treatment of mental disorders in primary care: a critical review of the literature. Psychosomatics 2000; 41(1): 39–52. [DOI] [PubMed] [Google Scholar]
  14. Kroenke K. Patients Presenting with Somatic Complaints in Primary Care. Presented at the Global Research in Anxiety and Depression Network Manic Depressive Disorders Conference, Martha's Vineyard MA, May 2002.
  15. Kupfer DJ. Long‐term treatment of depression Journal of Clinical Psychiatry 1991; 52(5): 28–34. [PubMed] [Google Scholar]
  16. Pincus HA, McQueen LS. US primary care training in mental health and the role of the DSM‐IV primary care version (DSM‐IV‐PC). Primary Care Psychiatry 1996; 2: 139–54. [Google Scholar]
  17. Pincus HA, Pechura CM, Elison L, et al. Depression in primary care: linking clinical and system strategies. General Hospital Psychiatry 2001; 23: 311–18. [DOI] [PubMed] [Google Scholar]
  18. Rost K, Smith R, Matthews DB, et al. The deliberate misdiagnosis of major depression in primary care. Archives of Family Medicine 1994; 3(4): 333–7. [DOI] [PubMed] [Google Scholar]
  19. Schoenbaum M. Improving depression treatment in primary care practices. American Journal of Managed Care 2000; 6(2): S53–S58. [PubMed] [Google Scholar]
  20. Schulberg HC, Katon WJ, Simon GE, et al., Treating major depression in primary care practice: an update of the Agency for Health Care Policy and Research Practice guidelines. Archives of General Psychiatry 1998. 55(12): 1121–7. [DOI] [PubMed] [Google Scholar]
  21. Schulberg HC. Treating depression in primary care practice. The Journal of Family Practice 2001; 50(6): 535–7. [PubMed] [Google Scholar]
  22. Simon GE, VonKorff M, Rutter C, et al. Randomized trial of monitoring, feedback and management of care by telephone to improve treatment of depression in primary care. British Medical Journal 2000; 320: 550–4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self‐report version of PRIME‐MD. Journal of the American Medical Association 1999; 282(18): 1737–44. [DOI] [PubMed] [Google Scholar]
  24. Tasman A, Riba MB, Silk KR. The Doctor‐patient Relationship in Pharmacotherapy: Improving Treatment Effectiveness. New York NY: The Guilford Press, 2000. [Google Scholar]
  25. Thase ME. Global Research in Anxiety and Depression Network Consensus Conference. Global Research in Anxiety and Depression Network: Martha's Vineyard MA, 2002.
  26. The Robert Wood Johnson Foundation . Rewarding Results: Aligning Incentives with High Quality Healthcare, 2002http://www.nhcpi.net/rewardingresults. [Google Scholar]
  27. Unutzer J, Katon W, Sullivan, et al. Treating depressed older adults in primary care: narrowing the gap between efficacy and effectiveness. Millbank Quarterly 1999. 77(2): 225–56. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Wagner E, Austin B, Davis C, et al. Improving chronic illness care: translating evidence into action. Health Affairs 2001; 20: 64–78. [DOI] [PubMed] [Google Scholar]
  29. Wagner EH, Austin BT, VonKorff M. Organizing care for patients with chronic illness. The Milbank Quarterly 1996. 74(4): 511–44. [PubMed] [Google Scholar]
  30. Wagner EH. The role of patient care teams in chronic disease management. British Medical Journal 2000; 320(7234): 569–72. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Wang PS, Simon GE, Kessler RC. The Economic Burdens from Depression and the cost‐effectiveness of Treatment. Presented at the Global Research in Anxiety and Depression Network Manic Depressive Disorders Consensus Conference, Martha's Vineyard MA, May 2002.
  32. Wells KB, Shelbourne CD, Schoenbaum M, et al. Impact of disseminating quality improvement programs for depression in managed primary care. Journal of the American Medical Association 2000; 283(2): 212–20. [DOI] [PubMed] [Google Scholar]

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