What is the evidence on effectiveness of capacity building of primary health care professionals in the detection, management and outcome of depression?

Summary

The issue

Depression is a common health care problem and is largely managed in primary care, with little or no specialist input from secondary care services. The quality of care is often low, with poor recognition of the condition, inadequate prescription, poor compliance with medication and poor provision and uptake of psychological interventions. Commonly advocated interventions on capacity building of primary health care professionals in the detection, management and outcome of depression include: clinician education, guidelines, collaborative care, case management and stepped care.

Findings

A substantial evidence base exists to support the effectiveness of collaborative care, case management and stepped care in improving patient adherence with treatment and improved clinical outcomes. Clinician education and guidelines, when offered by themselves, are largely ineffective strategies. A near uniform finding was that the improved outcomes of successful strategies are associated with increased health care costs.

Policy considerations

There is a substantial opportunity to improve the quality and outcome of primary care for depression. Improved quality of care will require a substantial investment in primary care services, and a reconfiguration of the roles and relationships between primary and secondary care. Some interventions, such as nurse case management, might be relatively low cost and be easily implemented within many health care settings. Improved outcome will require a greater allocation of resources to primary mental health care than is currently the case in many health care systems.