title: Chronic disease management for depression in US medical practices: results from the Health Tracking Physician Survey.
abstract: BACKGROUND
  Chronic care model (CCM) envisages a multicomponent systematic remodeling of ambulatory care to improve chronic diseases management. Application of CCM in primary care management of depression has traditionally lagged behind the application of this model in management of other common chronic illnesses. In past research, the use of CCM has been operationalized by measuring the use of evidence-based organized care management processes (CMPs).
  
  
  OBJECTIVE
  To compare the use of CMPs in treatment of depression with the use of these processes in treatment of diabetes and asthma and to examine practice-level correlates of this use.
  
  
  METHODS
  Using data from the 2008 Health Tracking Physician Survey, a nationally representative sample of physicians in the United States, we compared the use of 5 different CMPs: written guidelines in English and other languages for self-management, availability of staff to educate patients about self-management, availability of nurse care managers for care coordination, and group meetings of patients with staff. We further examined the association of practice-level characteristics with the use of the 5 CMPs for management of depression.
  
  
  RESULTS
  CMPs were more commonly used for management of diabetes and asthma than for depression. The use of CMPs for depression was more common in health maintenance organizations [adjusted odds ratios (AOR) ranging from 2.45 to 5.98 for different CMPs], in practices that provided physicians with feedback regarding quality of care to patients (AOR range, 1.42 to 1.69), and in practices with greater use of clinical information technology (AOR range, 1.06 to 1.11).
  
  
  CONCLUSIONS
  The application of CMPs in management of depression continues to lag behind other common chronic conditions. Feedbacks on quality of care and expanded use of information technology may improve application of CMPs for depression care in general medical settings.
authors: Departments of Health, Behavior and Society, John Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. wzafar@jhsph.edu
authors: Waleed
authors: W
authors: Zafar
authors: Ramin
authors: R
authors: Mojtabai
mesh_terms: D001249:Asthma / Q000628:therapy; D002908:Chronic Disease; D003266:Continuity of Patient Care / Q000458:organization & administration; D003863:Depression / Q000628:therapy*; D003920:Diabetes Mellitus / Q000628:therapy; D005260:Female; D019983:Guideline Adherence; D006280:Health Workforce / Q000458:organization & administration; D006801:Humans; D008297:Male; D010353:Patient Education as Topic / Q000458:organization & administration; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D011787:Quality of Health Care / Q000458:organization & administration*; D012648:Self Care / Q000379:methods; D014481:United States