Improving the management of late-life depression in primary care: barriers and facilitators.

Tamara Sussman,Lisa Van Bussel,Jane Mccusker,Maida Sewitch,Ilyan Ferrer,David Parry,Mark Yaffe

doi:10.1155/2011/326307

Abstract

The objectives of this study were to elicit Canadian health professionals' views on the barriers to identifying and treating late-life depression in primary care settings and on the solutions felt to be most important and feasible to implement. A consensus development process was used to generate, rank, and discuss solutions. Twenty-three health professionals participated in the consensus process. Results were analysed using quantitative and qualitative methods. Participants generated 12 solutions. One solution, developing mechanisms to increase family physicians' awareness of resources, was highly ranked for importance and feasibility by most participants. Another solution, providing family physicians with direct mental health support, was highly ranked as important but not as feasible by most participants. Deliberations emphasized the importance of case specific, as needed support based on the principles of shared care. The results suggest that practitioners highly value collaborative care but question the feasibility of implementing these principles in current Canadian primary care contexts.

Highlights

Significant depression is prevalent among 10–25% of older community-dwelling adults [1,2,3]
Conference attendees emphasized through their deliberations that the mental health and resource support family physicians required had to be (1) case specific, (2) provided by a trustworthy professional who was knowledgeable with mental health treatment and services, and (3) available as needed
Models of collaborative care that include provision of personalized support, as needed, to family physicians and that are based on shared care principles may be highly valued by family physicians, psychiatrists, nurses, and social workers in Canadian healthcare settings

Summary

Introduction

Significant depression is prevalent among 10–25% of older community-dwelling adults [1,2,3]. Depression is the most common late-life mental health disorder to present in primary care [7]. To date, few depressed older adults receive these treatments in primary care [8, 9]. This compromises older adults’ health, quality of life, and physical functioning [10] and increases their risk of mortality [5, 6], negatively impacts the health of their families [11], and augments health care costs [12, 13]

Objectives

Methods

Results

Discussion

Conclusion