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To the Editor: Dr Kessler and colleagues¹ referenced an article by us² to support their statement regarding physician reluctance to implement model primary care programs for the detection and treatment of depression. Although cost-effective programs for detection and treatment of depression in the primary care setting do exist,³ it was not our intent to single out primary care physicians for failing to implement new programs. In fact, the purpose of our article was to emphasize that there are multiple barriers requiring complex solutions, with involvement by multiple parties. As in other chronic illnesses, patients need support to enhance self-management, to link with community resources, and to demand quality care. Primary care physicians may need to improve their treatment skills, activate patients in a participatory process, and link to specialty expertise when appropriate. Clinics could restructure information systems and incorporate a longitudinal care model. Insurers can monitor and reward quality. Employers . . . [Full Text of this Article]

Harold Alan Pincus, MD
Department of Psychiatry
University of Pittsburgh School of Medicine
Pittsburgh, Pa

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