Psychiatric Quarterly [psaq] PH140-378646-04 October 4, 2002 14:4 Style ﬁle version June 4th, 2002
Psychiatric Quarterly, Vol. 74, No. 1, Spring 2003 (
The Management of Depression in Primary Care
Neil Korsen, M.D. and Steven E. Katz, M.D.
Depression is a common and signiﬁcant illness in primary care. It has
been reported that one half of patients with depression are treated
exclusively by primary care clinicians. Studies have also shown that
treatment and outcomes in usual practice are not as effective as in re-
search studies. Efforts to improve performance in primary care, includ-
ing clinician education and screening of patients in the waiting room for
depression have generally not been successful. It has been suggested
that a more systematic approach to depression care would lead to better
performance and outcomes, and a number of recent studies have shown
this to be true.
Several of these studies contained common elements that are consis-
tent with recommendations for improving chronic disease care which
were ﬁrst described in 1996 by Wagner and his colleagues at Group
Health Cooperative in Seattle as “The Chronic Care Model” (CCM).
The CCM has been shown to improve process and outcomes in a num-
ber of disparate chronic illnesses including depression. This model for
organizing care is different from the way most primary care practices
currently operate and therefore it has been difﬁcult for organizations to
sustain the positive changes of the research projects without support.
The four initiatives described share the characteristic of searching for
ways to continue these activities after the researchers are gone.
The articles in this section describe four efforts to improve depres-
sion care by incorporating the CCM into primary care practice. Korsen
et al report on the initial implementation of a multifaceted depression
improvement project funded by the MacArthur Foundation. Meresman
et al describe the Nurse Telecare model and its implementation at
Kaiser Permanente and in several other locations. Oishi et al offer the
2003 Human Sciences Press, Inc.