Wishing upon a STAR*D: the promise of ideal depression care by primary care providers.
The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial found that after initial treatment, depressed patients treated in primary care settings had the same or slightly better outcomes than those treated in specialty care settings. The authors describe challenges to using the STAR*D approach and protocols in usual primary care settings. These include inadequate availability of appointments, insufficient resources for care management and treatment monitoring, and lack of payment to primary care providers for providing mental health care. Substantial reengineering of payment and delivery systems is needed in order for the STAR*D approach to be viable in primary care clinics.
Ong
Michael K
MK
Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA. michael.ong@ucla.edu
Rubenstein
Lisa V
LV
D015283:Citalopram / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000628:therapy; D006297:Health Services Accessibility; D006801:Humans; D011320:Primary Health Care / Q000592:standards; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D017211:Treatment Failure; D016896:Treatment Outcome
D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors