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
|Contact: Warren Robak|