Collaborative Management to Achieve Depression Treatment Guidelines

Two models that integrate the psychiatrist into treatment of depression in primary care have beenevaluated in randomized controlled trials. In the psychiatrist/primary care model, a psychiatrist alternatedvisits with a primary care physician to assist in the education and pharmacologic treatment ofthe patient. In the psychiatrist/psychologist team model, the psychiatrist worked with a team of psychologiststo improve adherence to and effectiveness of antidepressant treatment, with psychologistsalso providing brief behavioral treatment in the primary care clinic. Findings with the psychiatry/primarycare model are reported. It was found that the collaborative model was associated with improvedadherence to treatment, increased patient satisfaction with depression care, and improved depressionoutcome compared with usual care by primary care physicians alone. Similar results were found in thestudy of the psychiatrist/psychologist collaborative care model. The success of these models indicatesthe appropriateness of a novel role for the psychiatrist and psychologist, i.e., that of collaboration withprimary care physicians in care of the depressed patient in the primary care setting.