Depression in Primary Care: Linking Clinical and System Strategies

Field of Work: Using a chronic care model in primary care to recognize and treat depression.

Problem Synopsis: Although clinician researchers have developed effective models for recognizing and treating depression in primary care settings, depression still goes largely unrecognized and untreated by primary care providers.

A 1998 RWJF-funded study suggested that most health care practices face financial and organizational barriers to screening and treating patients for depression.

Synopsis of the Work: Depression in Primary Care: Linking Clinical and System Strategies—a $12 million national program funded by RWJF from 2000 to 2007—aimed to spur health care organizations to use a chronic care model to recognize and treat depression, and to develop financial and other incentives to support the use of the model.

Key Findings/Results

  • According to a report to RWJF from the national program office, Depression in Primary Care achieved the following results:

    • Numerous primary care practices adopted the chronic care model for treating depression. It included screening for depression; providing resources to providers and patients; and creating chronic illness registries to track their progress.
    • The majority of sites were less successful in sustaining new payment methods to pay for such care.
    • Depression in Primary Care helped close the divide between physical and behavioral health among clinicians, health plans, employers and researchers, according to Harold Pincus, M.D., program director, and Connie Pechura, former senior RWJF program officer.
    • The lessons learned from the Depression in Primary Care program continue to provide researchers and policy-makers with important information that can be used to inform changes in policy and practice as it relates to better integration of behavioral health and primary care.

"The program's major message was to eliminate duality of thinking between mental and general health, and between clinical and economic systems," said Pincus. "The program made major advances in providing an evidence base for doing that at a time when many states were debating parity between mental and physical health," Pechura concurred.