Primary care practices ill equipped to manage patients' depression

While most people with depression seek help from their primary care doctors, a new study suggests primary care practices may not be well equipped to manage the condition.

In contrast to how they manage other common chronic conditions, many practices do not use depression care management processes, according to the study, published in the March issue of Health Affairs. The finding may indicate that primary care practices in the U.S. are not prepared to manage depression as a chronic illness, despite the high number of patients they treat, the study authors said. More than 4 million patients visit primary care doctors for depression each year in the U.S.

However, in many primary care practices, physicians don't teach patients how to manage their care and don't follow-up regularly to track how they are responding to treatment, an approach considered most effective for treating chronic illnesses, according to a Kaiser Health News (KHN) report on the study.

Researchers used data from the National Study of Physician Organizations survey to assess how well more than 1,000 primary care practices managed care for four chronic conditions: asthma, depression, diabetes and congestive heart failure. They looked at how often practices used five specific best practices to manage those chronic conditions: employing nurse care managers, keeping a registry of patients with a condition that requires regular follow-up, reminding patients to comply with treatment, teaching them about their condition and providing feedback to the physician.

The overall mean score for care management was 4.8, but depression care scored significantly lower (0.8), indicating that practices used less than one care management process for depression, the study found. For instance, less than 10 percent of practices reminded patients about their treatments or taught them about depression.

While use of diabetes care management practices increased significantly among larger practices during the study period from 2006 to 2013, the level of use of depression management practices had not changed, regardless of practice size, the researchers said.

"If we actually treat depression as a chronic illness and use the level of tools we're using for diabetes, then we'll be able to better treat patients--and help them live healthier lives and more productive lives," lead study author Tara Bishop, M.D., an associate professor of healthcare policy and research at Weill Cornell Medical College, told KHN.

When it comes to treating depression, some clinicians tend to leave price and insurance coverage out of the equation when speaking with patients, as FiercePracticeManagement previously reported. Ironically perhaps, both physicians and nurses suffer themselves from high rates of depression.

To learn more:
- here's the study abstract
- read the Kaiser Health News article