Managing late‐life depression in primary care practice: a case study of the Health Specialist's role

Abstract

Complexities in the diagnosis and treatment of late-life depression have stimulated various strategies for assisting the primary care physician to fulfil these tasks more effectively. The role of Health Specialist was developed for this purpose in a study to reduce suicidality among older depressed patients. This role includes clinical and case management tasks which aim to provide the physician with timely, patient-specific information and recommendations. Evolution of this role and its rewards/stressors during the study's first year are described.

Treating late‐life depression with interpersonal psychotherapy in the primary care sector

“…A Depression Care Manager (DCM) assigned to the practice would administer the IPT (Schulberg et al, 2001). This time-limited psychotherapy was to be available for patients who declined pharmacotherapy as well as for patients requiring a psychosocial intervention alone or in combination with a medication given the patient's interpersonal stressors or the depressive episode's clinical complexity.…”

The Effect of a Primary Care Practice–Based Depression Intervention on Mortality in Older Adults

“…In both study groups, physicians were informed by letter if patients reported any suicidal ideation and immediately when patients were identified as being at high risk for suicide according to prespecified guidelines. Other sources detail the PROSPECT treatment algorithm and implementation, including the role of the care manager (29), strategy for pharmacotherapy (28), management of suicidal ideation (30,31), and types and proportions of treatment received over time by patients in practices randomly assigned to the intervention or to usual care (14,32).…”

Patterns of Early Adherence to the Antidepressant Citalopram among Older Primary Care Patients: The Prospect Study

“…To increase the sensitivity of the screening procedure, patients with CES-D <20 and not selected for the 5% random sample were also recruited if they reported history of depression or antidepressant treatment. Details of the study design of the PROSPECT Study are available elsewhere [28][29][30]. The study protocols were approved by the Institutional Review Boards of the Cornell University, University of Pittsburgh, and University of Pennsylvania Schools of Medicine.…”