title: Practice-based depression case management in primary care: a qualitative study on family doctors' perspectives.
abstract: BACKGROUND
  Case management provided by health care assistants (HCAs) is effective in improving primary care for depressive patients. Little is known on the implementation-related aspects of case management performed in small family practices.
  
  
  OBJECTIVE
  To explore family doctors' perspectives on clinical and organizational aspects of implementation of case management and perceived practice-related aspects associated with patient care after 1 year's experience of HCAs providing case management for depressive patients in their practices.
  
  
  METHODS
  This qualitative study was nested in a cluster-randomized trial on case management provided by practice-based HCAs for patients with major depression in Germany. We used semi-structured interview guides and performed audio-taped interviews with family doctors. Full transcription and thematic content analysis were carried out.
  
  
  RESULTS
  Twenty-three family doctors were interviewed. The family doctors perceived case management as beneficial to patients and reported that it improved their consultation styles and doctor-patient relationships. They implemented case management elements into their everyday day work using 'concrete', 'subsumed' or 'progressive' implementation styles.
  
  
  CONCLUSIONS
  Family doctors perceived practice-based case management by HCAs as beneficial for patient care. Different implementation styles may be appropriate, depending on the health care setting, and this requires further evaluation.
authors: Institute of General Practice, Jena University Hospital, Germany. jochen.gensichen@med.uni-jena.de
authors: J
authors: J
authors: Gensichen
authors: C
authors: C
authors: Güthlin
authors: V
authors: V
authors: Kleppel
authors: C
authors: C
authors: Jäger
authors: K
authors: K
authors: Mergenthal
authors: F M
authors: FM
authors: Gerlach
authors: J J
authors: JJ
authors: Petersen
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D019090:Case Management / Q000458:organization & administration*; D003863:Depression / Q000628:therapy*; D005260:Female; D005858:Germany; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010823:Physician Assistants / Q000458:organization & administration*; D010819:Physician's Role; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000523:psychology*; D011320:Primary Health Care / Q000458:organization & administration*