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December 2004 (Volume 82)
Amy M. Kilbourne
Herbert C. Schulberg
Edward P. Post
Bruce L. Rollman
Bea Herbeck Belnap
Harold Alan Pincus
Milbank Memorial Fund
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Randomized controlled trials have demonstrated the efficacy and cost-effectiveness of using treatment models for major depression in primary care settings. Nonetheless, translating these models into enduring changes in routine primary care has proved difficult. Various health system and organizational barriers prevent the integration of these models into primary care settings. This article discusses barriers to introducing and sustaining evidence-based depression management services in community-based primary care practices and suggests organizational and financial solutions based on the Robert Wood Johnson Foundation Depression in Primary Care Program. It focuses on strategies to improve depression care in medical settings based on adaptations of the chronic care model and discusses the challenges of implementing evidence-based depression care given the structural, financial, and cultural separation between mental health and general medical care.
Author(s): Amy M. Kilbourne; Herbert C. Schulberg; Edward P. Post; Bruce L. Rollman; Bea Herbeck Belnap; Harold Alan Pincus
Keywords: patient care management; delivery of health care; integrated quality of care; depressive disorder; depression
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Volume 82, Issue 4 (pages 631–659) DOI: 10.1111/j.0887-378X.2004.00326.x Published in 2004
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The Milbank Quarterly’s multidisciplinary approach and commitment to applying the best empirical research to practical policymaking offers in-depth assessments of the social, economic, historical, legal, and ethical dimensions of health and health care policy.