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Wishing Upon a STAR*D: The Promise of Ideal Depression Care by Primary Care Providers

Dr. Ong is affiliated with the Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 911 Broxton Ave., 1st Floor, Los Angeles, CA 90024 (e-mail: michael.ong{at}ucla.edu). Dr. Rubenstein is affiliated with the Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles. This commentary is part of a special section on the STAR*D trial (Sequenced Treatment Alternatives to Relieve Depression) and the implications of its findings for practice and policy. Grayson S. Norquist, M.D., M.S.P.H., served as guest editor of the special section.

The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial found that after initial treatment, depressed patients treated in primary care settings had the same or slightly better outcomes than those treated in specialty care settings. The authors describe challenges to using the STAR*D approach and protocols in usual primary care settings. These include inadequate availability of appointments, insufficient resources for care management and treatment monitoring, and lack of payment to primary care providers for providing mental health care. Substantial reengineering of payment and delivery systems is needed in order for the STAR*D approach to be viable in primary care clinics.

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				G. S. Norquist Introduction to the STAR*D Special Section Psychiatr Serv, November 1, 2009; 60(11): 1437 - 1438. [Full Text] [PDF]

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