Translating a guideline into practice: The USPSTF recommendations on screening for depression in adults.

Depression is a problem commonly seen in primary care, often as a comorbidity of chronic conditions, such as diabetes mellitus, coronary heart disease, and chronic obstructive pulmonary disease. Comorbid depression often leads to worse clinical outcomes.1,2 In 2009, the U.S. Preventive Services Task Force (USPSTF) reaffirmed its support for screening for depression in adults, and expanded on its caveat that screening is effective only if support systems are in place for appropriate treatment of patients with positive screening results. Specifically, the USPSTF “recommends screening adults for depression when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up.”3 Recognizing the prevalence of depression and its impact on other chronic conditions, MaineHealth, an integrated health care delivery system in southern and central Maine, developed a quality improvement program for depression in primary care.4,5 The program incorporates four supports for staff-assisted depression care: • Using a standardized instrument to screen for depression and to monitor response to treatment. • Using a registry to track patient progress and key aspects of depression care. • Encouraging self-management by providing education for patients and family members about depression, and providing support for patients to make behavior changes that will enhance their care. • Providing care management through communication between patients and a staff member to address treatment adherence, self-management activities, and response to treatment.