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Primary Care Clinicians’ Recognition and Management of Depression: A Model of Depression Care in Real-World Primary Care Practice

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ABSTRACT

BACKGROUND

Depression is prevalent in primary care (PC) practices and poses a considerable public health burden in the United States. Despite nearly four decades of efforts to improve depression care quality in PC practices, a gap remains between desired treatment outcomes and the reality of how depression care is delivered.

OBJECTIVE

This article presents a real-world PC practice model of depression care, elucidating the processes and their influencing conditions.

DESIGN

Grounded theory methodology was used for the data collection and analysis to develop a depression care model. Data were collected from 70 individual interviews (60 to 70 min each), three focus group interviews (n = 24, 2 h each), two surveys per clinician, and investigators’ field notes on practice environments. Interviews were audiotaped and transcribed for analysis. Surveys and field notes complemented interview data.

PARTICIPANTS

Seventy primary care clinicians from 52 PC offices in the Midwest: 28 general internists, 28 family physicians, and 14 nurse practitioners.

KEY RESULTS

A depression care model was developed that illustrates how real-world conditions infuse complexity into each step of the depression care process. Depression care in PC settings is mediated through clinicians’ interactions with patients, practice, and the local community. A clinician’s interactional familiarity (“familiarity capital”) was a powerful facilitator for depression care. For the recognition of depression, three previously reported processes and three conditions were confirmed. For the management of depression, 13 processes and 11 conditions were identified. Empowering the patient was a parallel process to the management of depression.

CONCLUSIONS

The clinician’s ability to develop and utilize interactional relationships and resources needed to recognize and treat a person with depression is key to depression care in primary care settings. The interactional context of depression care makes empowering the patient central to depression care delivery.

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Acknowledgements

Contributors

We would like to thank all the clinicians who participated in this study for their time as well as their genuine and candid perspectives on their everyday practices and on depression care. We also thank the DEED project investigators for their participation in ongoing data analysis: Dr. Jean Anthony, Dr. Barbara Bowers, Dr. Jeffery Susman, and Dr. Bas Tidjani.

Funder

This study was fully funded by the National Institute of Mental Health (R34 071719).

Prior presentations

Portions of the manuscript content have been presented at the following national conferences:

Integrating Service, Integrating Research for Co-Occurring Conditions: A Need for Views and Action, March 2–3, 2009. Washington, DC.

AcademyHealth Annual Research Meeting, June 28–30, 2009. Chicago, IL.

AcademyHealth Annual Research Meeting, June 27–29, 2010. Boston, MA.

Conflict of Interest

The authors declare that they do not have any conflicts of interest.

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Authors and Affiliations

  1. University of Cincinnati, P.O. Box 210038, Cincinnati, OH, 45221-0038, USA

    Seong-Yi Baik PhD

  2. UMDNJ Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Benjamin F. Crabtree PhD

  3. University of Texas-El Paso, El Paso, TX, USA

    Junius J. Gonzales MD, MBA

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  1. Seong-Yi Baik PhD
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  2. Benjamin F. Crabtree PhD
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  3. Junius J. Gonzales MD, MBA
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Corresponding author

Correspondence to Seong-Yi Baik PhD.

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Baik, SY., Crabtree, B.F. & Gonzales, J.J. Primary Care Clinicians’ Recognition and Management of Depression: A Model of Depression Care in Real-World Primary Care Practice. J GEN INTERN MED 28, 1430–1439 (2013). https://doi.org/10.1007/s11606-013-2468-3

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