THE CHRONIC DISEASE MANAGEMENT MODEL FOR DEPRESSION IN PRIMARY CARE

Objective: This paper reviews the development of chronic disease management approaches, and explores the suitability and effectiveness of these ways of organizing care for depression. Method: The relevant literature including systematic reviews, service evaluations, and clinical guidelines have been appraised to provide a review of the development of health care management approaches for long term conditions and their application to depression. Results: The chronic care model originally developed in the USA has been successfully adopted in other countries, and has been applied to the management of depression in primary care. This multicomponent approach involves enhanced collaboration between primary and secondary care clinicians often by means of case managers, support for improved patient self-management, and systematic follow-up. These approaches to health care organization significantly enhance the quality of care for depression: reviews consistently show improvements in depression severity, treatment adherence, and patient satisfaction. Conclusions: There appears value in the continued use of chronic disease management approaches for depression in primary care. For depression alone and depression combined with medical conditions there is consistent evidence for beneficial effects on depression outcomes. However there remain challenges in tailoring these approaches to influence physical outcomes in patients with medical comorbidity.