Treatment of depression in primary care

BMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b934 (Published 19 March 2009) Cite this as: BMJ 2009;338:b934
  1. Chris van Weel, professor of general practice,
  2. Evelyn van Weel-Baumgarten, associate professor of medical communications skills,
  3. Eric van Rijswijk, general practitioner
  1. 1Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, Netherlands
  1. C.vanweel{at}hag.umcn.nl

    Incentivised care is no substitute for professional judgment

    Patients with chronic depression commonly present to general practice,1 and they often have other important (physical) diseases.2 Although effective treatment is available, evidence suggests that patients and practitioners make insufficient use of it.3 These are important reasons to improve general practitioners’ care of depression, as pursued by the World Health Organization action to integrate mental health into primary care.4 In England and Scotland, the quality and outcomes framework (QOF) identifies evidence based interventions and provides financial incentives to practices that implement these interventions. This exciting and innovative approach to improving performance is followed with interest outside the United Kingdom.

    Two linked studies look at the QOF system and the management of depression in primary care. Kendrick and colleagues (doi:10.1136/bmj.b750) assess whether rates of prescribing antidepressant drugs and referrals to specialist services vary according to patients’ scores on incentivised depression questionnaires.5 Validated screening instruments to assess the severity of depression include the hospital anxiety and depression …

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