DEVELOPMENT OF A MODEL FOR THE
DETECTION AND TREATMENT OF
DEPRESSION IN PRIMARY CARE
Joel A. Feinman, Ph.D., Doreen Cardillo, M.S.,
Jeffrey Palmer, M.D., and Mary Mitchel, R.N., B.S.N.
Development and implementation of a protocol for identifying and treating de-
pressed patients in a busy, group model, HMO primary care practice is de-
scribed. Initial results and barriers to implementation are reported. A simple
depression screening tool was adapted and a protocol for using available primary
care staff and resources was developed to efﬁciently integrate screening and
treatment for depression into daily practice. Important components of the pro-
gram included speciﬁcation of the target population, adaptation of a patient self-
report diagnostic and rating tool, a nurse-educator protocol for patient follow-up
and telephone support, a database to track patient progress, training for pri-
mary care staff, and collaboration with specialty Behavioral Health Care. After
piloting, plans were made for transferring the model to other practices. Although
the protocol was seen as beneﬁcial to the PCP, Nurses, and patients involved,
the scarcity of resources in other primary care practices proved a major barrier
to full implementation.
If a family doctor had to choose an ‘‘ideal illness’’ to treat in a
primary care setting, it would likely be an illness that is highly
prevalent, causes high rates of disability, places great stress on
The authors are afﬁliated with Kaiser Permanente, Northeast Division.
Address correspondence to Joel A. Feinman, Ph.D., 389 Bernardston Road,
Greenﬁeld, Massachusetts 01301.
PSYCHIATRIC QUARTERLY, Vol. 71, No. 1, Spring 2000
0033-2720/00/0300-0059$18.00/0 2000 Human Sciences Press, Inc.