THE USUAL CARE OF MAJOR DEPRESSION IN PRIMARY-CARE PRACTICE

Objective: To determine how primary care physicians treat patients wit h major depression in the course of routine practice and the degree to which such practice produces outcomes anticipated with interventions recommended by the Agency for Health Care Policy and Research Depressi on Guideline Panel. Design: Prospective cohort study. Settings: Academ ically affiliated ambulatory family practice centers and internal medi cine clinics in urban neighborhoods of Pittsburgh, Pa. Patients: Ninet y-two patients who were seen in primary care practices and who met cri teria for a current major depression as determined by the Diagnostic I nterview Schedule and a psychiatrist's assessment. Intervention: Physi cians were informed of the patient's psychiatric diagnosis, and were u rged to treat it in whatever manner and for whatever duration they dee med appropriate tie, with ''usual care''). Main Outcome Measures: The treatments that were provided, the patients' clinical course, and the relationship between the type of treatment and clinical course. Result s: Health center records indicated that 67 patients (73%) received a d epression-specific treatment in the 8 months following study entry, A majority of the total cohort were prescribed an antidepressant drug. O f the 92 patients, 18 (20%) were asymptomatic at 8 months (Hamilton Ra ting Scale for Depression scare, less than or equal to 7), The treatme nt pattern was not clearly related to the clinical course. Conclusions : The recovery rates for the patients with major depression who were t reated with usual care in routine primary care practices were lower th an those anticipated from treatments consistent with the Agency for He alth Care Policy and Research guidelines. Further studies of the careg iving elements that influence the effectiveness of depression-specific treatments of patients in primary cart settings are needed.