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STUDY FINDS PRIMARY CARE DEPRESSION TREATMENT
OFTEN DOES NOT FOLLOW QUALITY GUIDELINES --
"These
findings are important for patients since most
cases of
depression are diagnosed and treated in primary
care settings."
Note that the VA was included in this research.
For more on depression, use the VA Watchdog
search engine...click here...
http://www.yourvabenefits.org/ses
search.php?q=depression&op=and
Story here...
http://www.eurekalert
.org/pub_releases/2007-09
/rc-sfp090407.php
Story below:
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Study finds primary care depression treatment
often does not follow quality guidelines
Most patients with depression who are treated by primary care physicians
do not receive care consistent with quality standards, according to a
new RAND Corporation study.
Physicians had high rates of adherence to just one third of the 20
measures of quality that researchers examined and had low rates of
adherence to nearly half of the treatment recommendations studied,
according to the report in the September 4 edition of the Annals of
Internal Medicine.
"These findings are important for patients since most cases of
depression are diagnosed and treated in primary care settings," said
senior author Dr. Lisa V. Rubenstein, the study's senior author, and a
senior scientist at RAND, a nonprofit research organization, and a
physician at the Veterans Affairs Greater Los Angeles Healthcare System.
"This shows that additional efforts are needed to improve the treatment
of depression."
The study also found that patients who received better-quality care
reported fewer symptoms of depression up to two years after the start of
treatment. The findings are among the first linking quality guidelines
for depression treatment with improved patient outcomes in community
settings.
"These are initial findings, but they suggest that programs that
encourage doctors to follow treatment guidelines can help improve the
long-term outlook for people with depression," said Rubenstein, who also
is affiliated with the David Geffen School of Medicine at UCLA.
Previous studies have shown that primary care providers do a poor job
following guidelines for antidepressant use or psychotherapy. The RAND
study is one of the first to assess primary care providers' adherence to
a comprehensive set of treatment guidelines for depression.
Researchers from RAND Health examined the experiences of health care
providers and patients who took part from 1996 to 1998 in the Quality
Improvement for Depression collaboration, which was designed to
encourage primary care providers to adopt comprehensive depression
treatment guidelines developed by the U.S. Agency for Healthcare
Research and Quality.
The RAND study examined the experiences of 1,131 patients with
depression who were treated in 45 primary care practices across 13
states. Study sites ranged from small private practices to large managed
care organizations. About 10 percent of patients in the study were from
Veterans Affairs practices.
Researchers examined whether physicians and other health providers
followed 20 different measures of quality, as well as analyzing
patients' reports about the status of their depression at 12, 18 and 24
months after starting treatment.
The study found that most primary care physicians did a good job of
diagnosing and beginning treatment for depression, with guidelines aimed
at these issues followed more than 70 percent of the time. These
guidelines includes items such as talking to patients about depression
and closely monitoring patients newly placed on antidepressant
medication.
But researchers found that primary care clinicians did less well
following up with treatment over time. Fewer than half of the patients
in the study completed the minimal course of treatment for either
antidepressant drugs or psychotherapy, and only slightly more than half
the depressed patients who were not treated were monitored closely.
The lowest quality of care occurred among the patients who exhibited the
most serious symptoms, including patients who showed evidence of suicide
or substance abuse. For example, among patients who had a previous
suicide attempt, just 35 percent were referred to a mental health
specialist over the next six months
"Primary care physicians were good at diagnosing depression, but they
did not do as good a good job of managing the sickest patients,"
Rubenstein said. "Right now, primary care physicians don't have the
tools necessary to decide which patients to treat and which to refer on
to specialized mental health care."
Receiving higher quality care did not appear to significantly impact the
long-term functioning of less-sick patients, according to the study. But
sicker patients who received better quality care were significantly less
likely to report continuing symptoms of depression on surveys taken up
to two years after their treatment began.
"For the people who were sicker, there was a closer relationship between
quality and their symptoms over the long term," Rubenstein said. "This
is among the first evidence that following treatment guidelines can help
patients over the long term."
###
Other authors of the report are Kimberly A. Hepner, Melissa Rowe, Scot
C. Hickey, Cathy D. Sherbourne and Lisa S. Meredith of RAND, Kathryn
Rost of Florida State University, Dr. Daniel E. Ford of Johns Hopkins
School of Medicine.
The research was supported by the National Institute of Mental Health,
the Agency for Healthcare Research and Quality, the John D. and
Catherine T. MacArthur Foundation and the Veterans Affairs Health
Services Research and Development Service Center of Excellence for the
Study of Healthcare Provider Behavior.
RAND Health, a division of the RAND Corporation, is the nation's largest
independent health policy research program, with a broad research
portfolio that focuses on health care quality, costs and delivery, among
other topics.
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Larry Scott --
