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

Article Figures & Data

Table 1.

The Three-Component Model: A Depression Management Office System.

Component	Responsibilities	Routines	Tools
Primary care clinician in a prepared practice	Recognition Management	Diagnostic assessment Follow-up visits^*	PHQ-913 Patient education materials Communication forms
Care manager	Promote adherence Monitor response	Periodic telephone calls^†	PHQ-9 Patient education materials Communication forms
Collaborating psychiatrist	Support care manager and primary care clinician	Weekly supervisory calls Informal advice	PHQ-9 Communication forms

Table 2.

Baseline Characteristics of Patients (n = 60).

Characteristic	Value
Age, years
Mean	47
Range	18–88
	No. (%)
Female	43 (72)
Initial diagnosis
MDD	15 (25)
CD	11 (18)
Both MDD and CD	22 (37)
Other	12 (20)
Does condition limit your function?
Extremely	6 (10)
Very much	21 (35)
Somewhat	31 (52)
Not at all	2 (3)
Initial management
Medication only	33 (55)
Psychological counseling only	4 (7)
Both	23 (38)

Note: MDD = major depressive disorder, CD = chronic depression. Other includes those with fewer or less severe depressive symptoms.

Table 3.

Baseline and Follow-up PHQ-9 Depression Severity Scores (n = 60 patients).

Baseline PHQ-9 Score	No.	Mean Score at 8 Weeks	≥5 Point Drop at 4 Weeks No. (%)	Score <5 at 8 Weeks No. (%)	Decrease of ≥50% from Baseline No. (%)
Severe major depression, ≥20	16	6.8	14 (88)	10 (63)	13 (82)
Moderately severe major depression, 5–19	16	6.8	14 (88)	10 (63)	10 (63)
Moderate depression symptoms, 10–14	18	5.3	14 (78)	12 (67)	13 (72)
Mild or minimal depression symptoms, <10	10	2.6	5 (50)	9 (90)	9 (100)

Table 4.

Care Manager Contact (n = 60 Patients).

Characteristics	Percent
Attempts needed to make first contact
1	54
2	18
3	7
≥4	12
Patients’ preferred time
7–10 am	41
11–2 pm	21
5–9 pm	39
Number of completed calls required
3	54
4	31
5	13
≥6	2

Table 5.

Initial Barriers to Care Reported by Patients (n = 30).*

Barriers to Care	No. (%)	Subsequently Resolved No. (%)
Ambivalence about medication	7 (23)	6 (86)
Medication side effects	15 (50)	13 (87)
Ambivalence about psychological counseling	2 (7)	1 (50)
Scheduling counseling	2 (6)	2 (100)
Psychological stressors	2 (10)	3 (67)
Insurance issues	3 (10)	3 (100)
Perceived treatment ineffective	3 (10)	3 (100)