J Clin Outcomes Manage
To screen or not to screen: is that the question? Improving the outcomes of depression in primary care
Ziffra MS, Friedman RS
Abstract Objective: To review the utility of screening in improving depression outcomes. Methods: Qualitative review of the literature. Results: Depression is highly prevalent in the community and in primary care settings and imposes a burden of illness greater than most chronic medical disorders. Standardized screening for depression in primary care has been recommended by a number of practice guidelines, yet there is minimal evidence for an impact of screening on patient outcome. Education of patients and providers has shown equally marginal impact. Improved outcomes for depression in primary care seem to hinge on more systematic depression management systems, involving more integration of specialized mental health services and primary care and more assertive outreach to follow depressed patients. Such interventions have been shown to have good cost-effectiveness. Conclusion: Efforts to improve outcomes of depression in primary care should move from emphasis on screening and education to the development of depression management systems that involve collaborative care by primary care providers and mental health professionals and active outreach to monitor compliance and response.
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