title: Improving access to depression care: descriptive report of a multidisciplinary primary care pilot service.
abstract: BACKGROUND
  Research has identified a need for improved depression care in primary care, while current United Kingdom (UK) health policy outlines standards for the management of the condition, including improved access to care. Innovative ways of working are needed to address these standards and provide better care.
  
  
  OBJECTIVE
  To pilot a multidisciplinary service for the management of depressed patients with a particular focus on facilitating access.
  
  
  METHODS
  Uncontrolled descriptive pilot study.
  
  
  METHODS
  One general practice in inner London.
  
  
  METHODS
  The service was advertised by post to all 6689 adult patients registered with the practice. It provided open access and face-to-face assessment by a specially trained primary care nurse for patients who considered themselves to be depressed. Following assessment, depressed patients received systematic telephone support from nursing staff in addition to the usual care from the general practitioners (GPs). The ser vice was evaluated for a 6-month period.
  
  
  RESULTS
  Sixty-six people, aged 19-77 years, 44 of them female, contacted the service, the majority in the first 2 months. Fifty-four patients were offered an assessment by the nurse. Thirty-five (80%) of the 44 attendees fulfilled criteria for major depression. Between them, the nurses and doctors achieved high levels of adherence to treatment and follow-up. This specialist service appears to have enabled a group of depressed patients, some of whom may not have sought or received help, to gain access to primary care. With appropriate supervision and training in depression care the nurses were able to assess and support depressed patients and this appeared to be acceptable to both patients and GPs.
  
  
  CONCLUSIONS
  In its present form the service would not be cost-effective. However, we believe it could be adapted to suit the needs of individual or clusters of practices incorporating key elements of the service (open access and case management, in particular), and further evaluation by a controlled trial is suggested.
authors.affiliation: Warwick House Medical Centre, Taunton.
authors.forename: Lorrie
authors.initials: L
authors.lastname: Symons
authors.forename: André
authors.initials: A
authors.lastname: Tylee
authors.forename: Anthony
authors.initials: A
authors.lastname: Mann
authors.forename: Roger
authors.initials: R
authors.lastname: Jones
authors.forename: Susan
authors.initials: S
authors.lastname: Plummer
authors.forename: Maria
authors.initials: M
authors.lastname: Walker
authors.forename: Carole
authors.initials: C
authors.lastname: Duff
authors.forename: Rebecca
authors.initials: R
authors.lastname: Holt
mesh_terms: D000328:Adult; D000368:Aged; D003156:Community Mental Health Services / Q000458:organization & administration / Q000592:standards*; D003866:Depressive Disorder / Q000628:therapy*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D009732:Nursing Care / Q000458:organization & administration / Q000592:standards; D010348:Patient Care Team; D017060:Patient Satisfaction; D010865:Pilot Projects; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards*; D015397:Program Evaluation