The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #56850

Linda Weinreb, MD¹, Carole Upshur, EdD¹, Annette Hanson, MD², and Michael Norton, MSW². (1) Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, 508-856-3225, weinrebl@ummhc.org, (2) Office of Clinical Affairs, Massachusetts Division of Medical Assistance, 600 Washington Street, Boston, MA 02111

There is increasing recognition of depression as a major chronic illness affecting 8-10% of the US adult population, and much higher proportions of disadvantaged populations. In 1990 it was ranked as the 4th highest cause of disability internationally. It is highly prevalent in adults with other chronic conditions such as asthma, diabetes and chronic heart disease. However, there is widespread evidence that depression frequently remains undiagnosed, and when treated, a majority of patients fail to sustain medications, therapy or self-management activities, resulting in repeat episodes of treatment initiation and high health care utilization. Patient behavior and lifestyle play important roles in symptom resolution, yet, like other chronic conditions neither the primary care system, nor the mental health system is adequately prepared to provide the structured support and patient self-management assistance required to successfully help patients with major depression. As part of the Robert Wood Johnson Foundation initiative on Depression in Primary Care, the University of Massachusetts Medical School’s Department of Family Medicine and Community Health in conjunction with the Massachusetts Division of Medical Assistance (i.e., Medicaid) has undertaken a demonstration project to test the implementation of the chronic care model for depression treatment of adult Medicaid patients in a range of primary care delivery sites.. This paper reports results of the first six months of implementation of the project which addresses the difficulties of integration between behavioral and physical health and treatment innovations in both primary care and mental health services that have resulted in improved patient outcomes.

Learning Objectives:

• At the end of the session the participant will be able to:
• 1)identify the mental health and primary care structural issues that prevent optimum depression care management;
• 2)understand the major elements of the chronic illness care model;
• 3)recognize key innovations that can be implemented in mental health and primary care to improve patient behavioral health outcomes;
• 4)understand patient support and self-management techniques for disadvantaged populations that can be implemented

Keywords: Depression, Mental Health

Related Web page: www.mcdpc.org

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.