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The presence of a psychiatrist in the primary care practitioner's (PCP's) office improves depression treatment but can increase the cost of care, at least in the short term. These investigators randomized 600 primary care patients who were beginning antidepressant treatment to receive telephone care management (TCM) alone provided by bachelor's-level case managers, TCM plus psychotherapy (TCM+P) provided by master's-level clinicians, or usual care. Psychiatric consultation was available for complex and refractory depression.
TCM consisted of brief, scripted telephone calls at 4, 8, and 16 weeks plus letters at 26 and 36 weeks after the initial prescription to monitor medication adherence, facilitate office follow-up, arrange consultations, a…