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October 15, 2003

Treatment of Depression by Mental Health Specialists and Primary Care PhysiciansTreatment of Depression by Mental Health Specialists and Primary Care Physicians

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(15):1991-1993. doi:10.1001/jama.290.15.1991-a

To the Editor: Dr Kessler and colleagues1 referenced an article by us2 to support their statement regarding physician reluctance to implement model primary care programs for the detection and treatment of depression. Although cost-effective programs for detection and treatment of depression in the primary care setting do exist,3 it was not our intent to single out primary care physicians for failing to implement new programs. In fact, the purpose of our article was to emphasize that there are multiple barriers requiring complex solutions, with involvement by multiple parties. As in other chronic illnesses, patients need support to enhance self-management, to link with community resources, and to demand quality care. Primary care physicians may need to improve their treatment skills, activate patients in a participatory process, and link to specialty expertise when appropriate. Clinics could restructure information systems and incorporate a longitudinal care model. Insurers can monitor and reward quality. Employers and policy makers could base purchasing decisions on measures of quality and value. Finally, community stakeholders could increase demand for quality care and enhance policy advocacy. Stigma and health financing policies that distinguish depression from other illnesses must be overcome.