What is the evidence on effectiveness of capacity building of primary health care professionals in the detection, management and outcome of depression? WHO/Europe 2004

Depression is a common healthcare 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.

This report reviews the substantial evidence base that 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 healthcare costs.