title: The 'usual care' of major depression in primary care practice.
abstract: OBJECTIVE
  To determine how primary care physicians treat patients with major depression in the course of routine practice and the degree to which such practice produces outcomes anticipated with interventions recommended by the Agency for Health Care Policy and Research Depression Guideline Panel.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Academically affiliated ambulatory family practice centers and internal medicine clinics in urban neighborhoods of Pittsburgh, Pa.
  
  
  METHODS
  Ninety-two patients who were seen in primary care practices and who met criteria for a current major depression as determined by the Diagnostic Interview Schedule and a psychiatrist's assessment.
  
  
  METHODS
  Physicians were informed of the patient's psychiatric diagnosis, and were urged to treat it in whatever manner and for whatever duration they deemed appropriate (ie, with "usual care").
  
  
  METHODS
  The treatments that were provided, the patients' clinical course, and the relationship between the type of treatment and clinical course.
  
  
  RESULTS
  Health center records indicated that 67 patients (73%) received a depression-specific treatment in the 8 months following study entry. A majority of the total cohort were prescribed an antidepressant drug. Of the 92 patients, 18 (20%) were asymptomatic at 8 months (Hamilton Rating Scale for Depression score, < or = 7). The treatment pattern was not clearly related to the clinical course.
  
  
  CONCLUSIONS
  The recovery rates for the patients with major depression who were treated with usual care in routine primary care practices were lower than those anticipated from treatments consistent with the Agency for Health Care Policy and Research guidelines. Further studies of the caregiving elements that influence the effectiveness of depression-specific treatments of patients in primary care settings are needed.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pa, USA.
authors.forename: H C
authors.initials: HC
authors.lastname: Schulberg
authors.forename: M R
authors.initials: MR
authors.lastname: Block
authors.forename: M J
authors.initials: MJ
authors.lastname: Madonia
authors.forename: C P
authors.initials: CP
authors.lastname: Scott
authors.forename: J R
authors.initials: JR
authors.lastname: Lave
authors.forename: E
authors.initials: E
authors.lastname: Rodriguez
authors.forename: J L
authors.initials: JL
authors.lastname: Coulehan
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D003866:Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D011446:Prospective Studies; D011613:Psychotherapy; D016896:Treatment Outcome; D014481:United States
chemical_list: D000928:Antidepressive Agents