Psychosomatics 43:441-450, December 2002
© 2002 The Academy of Psychosomatic Medicine
A Three-Component Model for Reengineering Systems for the Treatment of Depression in Primary Care
Thomas E. Oxman, M.D.,
Allen J. Dietrich, M.D.,
John W. Williams, Jr., M.D., M.H.S., and
Kurt Kroenke, M.D.
Presented in part at the 155th annual meeting of the American Psychiatric Association, Philadelphia, May 18–23, 2002. Received July 1, 2002; accepted July 11, 2001. From the Departments of Psychiatry and Community and Family Medicine, Dartmouth Medical School, Lebanon, N.H.; the Center for Health Services Research in Primary Care, Health Services Research and Development, Department of Veterans Affairs Medical Center, Durham, N.C.; Duke University Medical Center, Durham, N.C.; and the Regenstrief Institute for Health Care and Department of Medicine, Indiana University, Indianapolis. Address reprint requests to Dr. Oxman, Department of Psychiatry, DHMC, One Medical Center Dr., Lebanon, NH 03756; thomas.oxman{at}dartmouth.edu (e-mail).
Depression in primary care is a chronic disease. As with most chronic diseases, long-term adherence to treatment plans is problematic. Evidence-based systems of care address this problem, but persistence and dissemination of systems after testing is a new problem. The three-component model for the care of patients with depression is a system of widely applicable, easily transported strategies and materials to address dissemination. The three-component model provides a series of routines (processes for structured diagnostic and follow-up-care with a time line) and division of responsibility, including a role for a telephone care manager. In the three-component model, clinician and office education create a prepared practice that is predisposed to providing evidence-based depression management. Enabling elements include the telephone care managers, who are trained to promote adherence to a management plan, and a supervising psychiatrist. The key reinforcing element is care manager reports about patient response to treatment. The three-component model is bound together by a common depression diagnostic and severity measure that facilitates communication and treatment decisions.
Key Words: Depression
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