PT  - JOURNAL ARTICLE
AU  - Allen J. Dietrich
AU  - Thomas E. Oxman
AU  - Mary R. Burns
AU  - Charlotte W. Winchell
AU  - Tanya Chin
TI  - Application of a Depression Management Office System in Community Practice: A Demonstration
AID  - 10.3122/jabfm.16.2.107
DP  - 2003 Mar 01
TA  - The Journal of the American Board of Family Practice
PG  - 107--114
VI  - 16
IP  - 2
4099  - http://www.jabfm.org/content/16/2/107.short
4100  - http://www.jabfm.org/content/16/2/107.full
SO  - J Am Board Fam Med2003 Mar 01; 16
AB  - 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.