Follow-up and follow-through of depressed patients in primary care: the critical missing components of quality care.

Certainly we could improve our identification, diagnosis, and initial treatment approaches to the large numbers of depressed patients we see in primary care. However, until we have established the kind of systematic follow-up and follow-through that the US Preventive Services Task Force said is a prerequisite for its recommendation to routinely screen for depression, none of these earlier actions will make much difference. Recently, a number of controlled trials of innovative approaches to care management have demonstrated clearly how much patient outcomes are improved when systematic follow-up is in place. The problem is that there are few examples of such systems in real clinical practices. This article describes the main components of such a systematic approach.