Patients' perspectives on depression case management in general practice - A qualitative study

Objective: General practice-based case management is effective in improving symptoms, adherence, and the perceived process of care of patients living with major depression. The aim was to explore the patients' perceptions of practice-based depression case management, their satisfaction with it and how living with depression contextualizes case management. Methods: This qualitative study was nested in a large cluster-randomized controlled trial on the effectiveness of case management for patients living with major depression. Case management was provided over 12 months by practice-based health care assistants, who monitored symptoms. We undertook semi-structured interviews with 41 patients, then transcribed and analysed them using qualitative content analysis. Results: Patients described depression as the unfortunate situation, where loneliness and lack of energy lead to being unable to actively seek help. Case management was appreciated because of regular, proactive contact and support by health care assistants. It was crucial to patients that they could trust the health care assistant. Some patients complained that case management was undertaken too mechanically and lacked empathy. Conclusion: Patients living with depression may perceive practice-based case management as beneficial if carried out in a trustworthy and empathetic manner. Practice implications: General practices should ensure that depression case management is patient-centered and non-mechanical. (C) 2011 Elsevier Ireland Ltd. All rights reserved.