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The Journal of the American Board of Family Practice 16:107-114 (2003)
© 2003 American Board of Family Practice

Application of a Depression Management Office System in Community Practice: A Demonstration

Allen J. Dietrich, MD, Thomas E. Oxman, MD, Mary R. Burns, MS, Charlotte W. Winchell, MSW and Tanya Chin, MD

Department of Community and Family Medicine (AJD, MRB, CWW, TC), Dartmouth Medicine School, Hanover, NH
Department of Psychiatry (TEO), Dartmouth Medicine School, Hanover, NH

Correspondence: Address correspondence to Allen J. Dietrich, MD, Department of Community and Family Medicine, 7250 Strasenburgh Hall, Dartmouth Medical School, Hanover, NH 03755

Background: Recent studies provide new insights about strategies that improve depression outcomes. We explored the feasibility of implementing these strategies in community practices.

Methods: Clinicians followed an office system approach to management of depression. There were no controls. The office system was based on established routines performed by a primary care clinician working in a prepared practice, a telephone care manager, and a collaborating psychiatrist, all using a common severity monitoring tool.

Five practices with 18 clinicians participated. Sixty-six adult patients had depression diagnosed, and 60 (91%) received care according to the model through 8 weeks of follow-up visits. Depression outcomes were assessed using PHQ-9.

Results: At baseline, 48 (80%) patients met criteria for major depressive disorder, chronic depression, or both, while others had less severe symptoms. Of 32 patients with moderately severe or severe depression, the 8-week follow-up severity score decreased by >=50% for 23 (70%). Of patient barriers to adherence, ambivalence about treatment and medication side effects were most common. Most patients received three care manager telephone calls requiring 6 to 10 minutes each.

Conclusion: Application of the office system was feasible in this demonstration project. If results are confirmed in further studies, this approach will be appropriate for widespread application.




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