Select Journal or Resource JAMA & Archives Home JAMA Archives of   Dermatology   Facial Plastic Surgery   Family Medicine (1992-2000)   General Psychiatry   Internal Medicine   Neurology   Neurology and Psychiatry (1919-1959)   Ophthalmology   Otolaryngology—Head & Neck Surgery   Pediatrics & Adolescent Medicine   Surgery JAMA-français JAMA & Archives CME Calendar of Events JAMA Career Center For The Media JAMAevidence Peer Review Congress Student JAMA (1998-2004)

	Institution: STANFORD Univ Med Center  | My Account | E-mail Alerts | Access Rights | Sign In Vol. 6 No. 4, July 1997   Archives  •  Online Features ORIGINAL CONTRIBUTION  This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal The 'Usual Care' of Major Depression in Primary Care Practice Herbert C. Schulberg, PhD; Marian R. Block, MD; Michael J. Madonia, MSW; C. Paul Scott, MD; Judith R. Lave, PhD; Eric Rodriguez, MD; John L. Coulehan, MD Arch Fam Med. 1997;6(4):334-339. 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. Design Prospective cohort study. Settings Academically affiliated ambulatory family practice centers and internal medicine clinics in urban neighborhoods of Pittsburgh, Pa. Patients 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. Intervention 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"). Main Outcome Measures 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, 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. Author Affiliations From the Departments of Psychiatry (Drs Schulberg, Block, and Scott) and Medicine (Dr Rodriguez), University of Pittsburgh School of Medicine, the Department of Family Practice, the Western Pennsylvania Hospital (Dr Block and Mr Madonia), the St Margaret Memorial Hospital Family Practice Residency, Dr Scott, and the University of Pittsburgh Graduate School of Public Health (Dr Lave), Pittsburgh, Pa, and the State University of New York at Stony Brook (Dr Coulehan). THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES Selecting Among Second-Step Antidepressant Medication Monotherapies: Predictive Value of Clinical, Demographic, or First-Step Treatment Features Rush et al. Arch Gen Psychiatry 2008;65:870-880. ABSTRACT | FULL TEXT   Treatment of depression for patients with multiple sclerosis in neurology clinics Mohr et al. Mult Scler 2006;12:204-208. ABSTRACT   A Randomized Trial to Improve the Quality of Treatment for Panic and Generalized Anxiety Disorders in Primary Care Rollman et al. Arch Gen Psychiatry 2005;62:1332-1341. ABSTRACT | FULL TEXT   Pharmacological Treatment of Depression in Older Primary Care Patients: The PROSPECT Algorithm Mulsant et al. Focus 2004;2:253-259. ABSTRACT | FULL TEXT   Disease Management for Depression and At-Risk Drinking Via Telephone in an Older Population of Veterans Oslin et al. Psychosom. Med. 2003;65:931-937. ABSTRACT | FULL TEXT   "Usual Care" for Major Depression in the 1990s: Characteristics and Expert-Estimated Outcomes Horvitz-Lennon et al. Am. J. Psychiatry 2003;160:720-726. ABSTRACT | FULL TEXT   Cost-Effectiveness of a Collaborative Care Program for Primary Care Patients With Persistent Depression Simon et al. Am. J. Psychiatry 2001;158:1638-1644. ABSTRACT | FULL TEXT   A Randomized Trial of Relapse Prevention of Depression in Primary Care Katon et al. Arch Gen Psychiatry 2001;58:241-247. ABSTRACT | FULL TEXT   The Electronic Medical Record: A Randomized Trial of Its Impact on Primary Care Physicians' Initial Management of Major Depression Rollman et al. Arch Intern Med 2001;161:189-197. ABSTRACT | FULL TEXT   The Relationship Between Quality and Outcomes in Routine Depression Care Fortney et al. Psychiatr. Serv. 2001;52:56-62. ABSTRACT | FULL TEXT   Efficacy of Nurse Telehealth Care and Peer Support in Augmenting Treatment of Depression in Primary Care Hunkeler et al. Arch Fam Med 2000;9:700-708. ABSTRACT | FULL TEXT   Following Depression in Primary Care: Do Family Practice Physicians Ask About Depression at Different Rates Than Internal Medicine Physicians? Nichols and Brown Arch Fam Med 2000;9:478-482. ABSTRACT | FULL TEXT   Randomized Trial of a Depression Management Program in High Utilizers of Medical Care Katzelnick et al. Arch Fam Med 2000;9:345-351. ABSTRACT | FULL TEXT   Somatoform Symptoms and Treatment Nonadherence in Depressed Family Medicine Outpatients Keeley et al. Arch Fam Med 2000;9:46-54. ABSTRACT | FULL TEXT   Treating Major Depression in Primary Care Practice: An Update of the Agency for Health Care Policy and Research Practice Guidelines Schulberg et al. Arch Gen Psychiatry 1998;55:1121-1127. ABSTRACT | FULL TEXT   Cost-effectiveness of Treatments for Major Depression in Primary Care Practice Lave et al. Arch Gen Psychiatry 1998;55:645-651. ABSTRACT | FULL TEXT   DEPRESSION IN PRIMARY CARE: POORLY TREATED OR POORLY UNDERSTOOD? JWatch General 1997;1997:7-7. FULL TEXT   The 'Usual Care' of Depression Is Not 'Good Enough' Higgins Arch Fam Med 1997;6:340-341. ABSTRACT   HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | PHYSICIAN JOBS | HELP CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP   © 1997 American Medical Association. All Rights Reserved.