Care management for depression in primary care practice: findings from the RESPECT-depression trial
Open accessAbstract
PURPOSE: This qualitative study examined the barriers to adopting depression care management among 42 primary care clinicians in 30 practices. METHODS: The RESPECT-Depression trial worked collaboratively with 5 large health care organizations (and 60 primary care practices) to implement and disseminate an evidence-based intervention. This study used semistructured interviews with 42 primary care clinicians from 30 practice sites, 18 care managers, and 7 mental health professionals to explore experience and perceptions with depression care management for patients. Subject selection in 4 waves of interviews was driven by themes emerging from ongoing data analysis. RESULTS: Primary care clinicians reported broad appreciation of the benefits of depression care management for their patients. Lack of reimbursement and the competing demands of primary care were often cited as barriers. These clinicians at many levels of initial enthusiasm for care management increased their enthusiasm after experiencing care management through the project. Psychiatric oversight of the care manager with suggestions for the clinicians was widely seen as important and appropriate by clinicians, care managers, and psychiatrists. Clinicians and care managers emphasized the importance of establishing effective communication among themselves, as well as maintaining a consistent and continuous relationship with the patients. The clinicians were selective in which patients they referred for care management, and there was wide variation in opinion about which patients were optimal candidates. Care managers were able to operate both from within a practice and more centrally when specific attention was given to negotiating communication strategies with a clinician. CONCLUSIONS: Care management for depression is an attractive option for most primary care clinicians. Lack of reimbursement remains the single greatest obstacle to more widespread adoption.
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Mental health problems often go unrecognized and untreated in general practice.
“mental health problems often go unrecognized and untreated in general practice (25, 26)”
From Acceptance of smart sensing, its determinants, and the efficacy of an acceptance-facilitating intervention in people with diabetes: results from a randomized controlled trial (2024) · cites this paper as [25]
The paper’s introductory discussion says depression is common in primary care and that substantial deficits in the adequacy of its care remain. That supports a concern about depression treatment, but our copy does not say that mental health problems generally often go unrecognized or untreated. (LLM, conf=0.82)
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- Authors
- Nutting, P. A., Gallagher, K., Riley, K., White, S., Dickinson, W. P., Korsen, N., & Dietrich, A.
- Affiliations
- Center for Research Strategies (US)
- University of Colorado Health (US)
- Maine Medical Center (US)
- Dartmouth College (US)
- ORCID
- Dickinson, W. P.
- Venue
- The Annals of Family Medicine
- Publisher
- Annals of Family Medicine
- Published
- 2008-01-01
- Volume
- 6
- Issue
- 1
- Pages
- 30-37
- ISSN
- 1544-1709 (ISSN-L)
- 1544-1717
- PMC
- PMC2203406
- OpenAlex
- W2140623211
- Cited by
- 58
- References
- 41
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 1 · 2020: 1 · 2019: 2 · 2018: 1 · 2017: 1 · 2016: 6 · 2015: 2 · 2014: 9 · 2013: 3 · 2012: 10
- FWCI
- 11.60
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- The Annals of Family Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- depression care management, primary care providers, barriers to adoption, reimbursement, referral, implementation of evidence-based interventions
- MeSH terms
- Attitude of Health Personnel, Depression, Humans, Interprofessional Relations, Interviews as Topic, Patient Care Management, Patient Compliance, Physician-Patient Relations, Practice Patterns, Physicians', Primary Health Care, Reimbursement, Incentive, Time Factors, Workload, Qualitative Research
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