New structured approach to managing patients with depression in primary care

A questionnaire-based management algorithm for major depressive disorder in primary care is feasible, although attrition following treatment is high.

Of the 25,000 patients in primary care clinics in a large metropolitan area, 4,325 (17%) were screened positive for depression, of which 2,426 had clinician-diagnosed depressive disorder. Of the 2,160 patients who received 18 weeks of follow-up, 65% were treated with drugs. Remission, defined as a PHQ-9 score of less than five, was more common in patients who had at least three follow-up visits.

Of those who returned at least three times, 41.7% achieved remission. However, more than half of those diagnosed did not return for follow-up care. The results of this study suggest that patients with depression can be treated successfully using measures-based care as part of primary care, and a greater focus on patient education and care. Other approaches to reduce attrition may be necessary for patients who do not return to follow up care.