Strategies for effective management of depression in primary care

The diagnosis and treatment of depressive disorders are challenges to the p rimary care physician because of the condition's high prevalence and chroni city, the frequent occurence of medical and mental health comorbidities, pa tients' unwillingness to disclose a mental health history, and cost. Primar y care physicians also cite lack of time and managed care policies as major barriers to improving outcomes in patients with depression. A potentially more effective approach to treating depression is health mana gement, rather than traditional disease management. In this approach, the f ocus of care is patients' functional status and quality of life rather than the treatment of a specific health condition in isolation; patients are ac tively involved with care, and care choices are driven by competing demands . Another approach that may help improve outcomes in depression is the Recogn ize, Assess, Categorize, and Treat (ReACT) strategy, which is an efficient way to detect and triage patients with depressive disorders according to th e severity of illness. Adjunctive aids, such as the use of support staff, m onitoring systems, and collaborative care with mental health specialists, a lso have great potential for improving primary care physicians' effectivene ss ill treating depression.