Today's treatments for depression can leave a lot to be desired, but new pills or modes of therapy are not necessarily the answer. Rather, simple changes in how existing treatments are delivered can yield significant improvements.

A new study, published in this week's issue of the British Medical Journal, found that inexpensive enhancements to care by primary care physicians, such as followup phone calls to patients, could boost response to treatment by almost 30 percent.

Perhaps as significant as that finding, however, is that the five large U.S. medical groups involved in the study, including Highmark Blue Cross Blue Shield, have decided to make the changes permanent.

"It's not a complex intervention," said Dr. Alan Axelson, Highmark's medical director for behavioral health, and it costs little more than the standard care already provided by primary care physicians.

The U.S. Army, also intrigued by the findings, this fall will see if the primary-care-focused approach helps soldiers returning to Fort Bragg, N.C., from combat duty.

"We're very enthusiastic," said Dr. Charles Engel, director of the Deployment Health Clinical Center at Walter Reed Army Medical Center, noting studies have shown up to 17 percent of soldiers are returning from Iraq with major depression, generalized anxiety or post-traumatic stress disorder.

The findings of the latest study are hardly unique, said Dr. Benoit Mulsant, a psychiatrist at the University of Pittsburgh School of Medicine, who was not part of the study. What is most encouraging, even "wonderful," he added, is that medical groups indicate they are finally adopting the methods for their everyday practice.

Depression is a staggering problem in health care today, affecting about one out of every 10 Americans, so even small improvements in care could bring relief to millions.

Yet Dr. Allen Dietrich, a professor of community and family medicine at Dartmouth Medical School and lead investigator of the new study, noted that the realities of today's health care system are such that any changes in treatment delivery will need to be of modest cost and take advantage of existing resources as much as possible.

The approach used by Dietrich and his colleagues, sponsored by the MacArthur Initiative on Depression and Primary Care, is called the Three Component Model.

Primary care physicians, who already treat most people with depression, continue to direct treatment, which often includes anti-depressant medication. Afterward, a group of "care managers," such as nurses, phone the patients periodically to see how they're doing and report back to the physicians if necessary.

In Highmark's case, the care managers are the nurses of its existing Blues on Call service.

A psychiatrist consults with the care managers weekly and, if necessary, suggests changes in medication or care if the patient isn't responding to or complying with treatment.

"In some cases, [the telephone support] was really important to keep people in treatment," Axelson said.

Some patients leave doctors' offices with prescriptions and, for whatever reason, never get them filled. Others stop taking medications when they start to feel better or when they suffer side effects. The phone calls can provide encouragement to continue treatments or to return to physicians to seek alternatives.

"It's not just medication," Axelson emphasized, noting that increased social activities or stress reduction also can reduce depression.

In the study, 405 patients in Pittsburgh, Denver, Salt Lake City, Bloomfield, Conn., and Portland, Maine, were randomly assigned to either standard care or the enhanced approach. At six months, 60 percent of the patients had responded to the enhanced treatment, compared with 47 percent who received the usual care.

Pitt's Mulsant noted that even the patients who received usual care in the study did better than most patients treated for depression -- typically, only 30 percent to 35 percent of patients respond to treatments in most practices.

"It's well documented that patients don't do as well in practice as they do in a research study," Mulsant said. The extra attention and followup given to patients in research studies is such that even those research subjects who receive sugar pills can often do better than patients in everyday practices who are prescribed active drugs.

Dietrich said he and his colleagues tried to bridge that gap between research and practice by relying as much as possible on existing resources, such as the quality improvement programs found in most large health care organizations.

Those resources may not be available to all physicians, particularly those in solo and small practices. But those who would like to adapt the system can download materials for free from the Web site: www.depression-primarycare.org/clinicians/re_engineering.

Axelson said the approach costs Highmark little extra. The system calls for physicians to evaluate patients for depression using a nine-question survey known as the PHQ-9. Also, Blues on Call, which performs followup calls, already is a budgeted service for its members.

Highmark began implementing the system in the past couple of months, sending resource kits to doctors and encouraging them to request the additional support available through Blues on Call.

Engel said the Army is modifying the system and will test it next month at Fort Bragg.

Offering depression treatment in a primary care setting promises to reduce the stigma that often makes soldiers hesitant to seek help, he said.