Quality improvement research on late life depression in primary care

BACKGROUND. Two million older Americans suffer from depression annually. De pression causes more functional impairment than many other common medical c onditions and older adults have the highest rate of suicide in the United S tates. Although many of these patients fail to seek or fail to receive care for depression, the majority will be seen in primary care for the treatmen t of other conditions. OBJECTIVES. To review the health services research on quality improvement f or late Life depression. METHODS. Qualitative literature review. RESULTS. During the past 30 years, multiple educational and quality improve ment interventions have been designed and tested to improve the recognition and treatment of depression in primary care settings. The findings from th is large body of health services research suggest that: (I) The outcome of major depression in The usual care of primary care is typically poor; this is particularly true of date life depression; (2) informational support pro vided to primary care physicians is necessary but insufficient to improve t he outcomes of late Life depression in primary care; achieving guideline-le vel Therapy requires The substantial participation of an informed and motiv ated patient working in concert with a health care team and health care sys tem designed to care for chronic conditions; (3) up to 30% of older primary care patients will fail to respond to excellent guideline-level therapy pr ovided in primary care; and (4) the latest quality improvement efforts focu s not only on the clinical skills of primary care physicians, but also an p atient's self-care and on innovative strategies To improve the system of ca re. CONCLUSIONS. Late life depression is often a chronic disease and outcomes r esearch demonstrates That quality improvement efforts That focus resources on improving systems of care and The active participation of patients offer The best evidence of improved patient outcomes.