Follow-Up Care of Patients with Newly Diagnosed Depression After Widespread Implementation of Telemedicine

Context: Patients who are diagnosed with depression often do not get any follow-up care. This deficiency led to a national HEDIS measure that calls for patients to get follow-up care within the first 30 days of being screened positive for depression. Studies have shown that depression outcomes improve with closer follow-up care.

Objective: To compare the change in percentage of follow-up care in newly diagnosed depression over a two-year period, specifically examining the pre-pandemic and pandemic eras. To determine if the increased usage of telemedicine in the pandemic era led to an increase in HEDIS-defined follow-up care for newly diagnosed patients with depression.

Study Design and Analysis: Prospective observational design. Chi-square and T-tests were used to determine statistical significance at p-value<=0.05.

Setting or Dataset: All patient encounters between February 1, 2019-January 31, 2020 (pre-pandemic) and February 1, 2020-January 31, 2021 (pandemic) in the Kaiser Permanente Southern California (KPSC) database were evaluated for new diagnosis of depression and 30 day follow-up for the depression.

Population Studied: Patients within the KPSC medical system with a new diagnosis of depression based on ICD-10 codes within the last 365 days. Patients were excluded if they had a diagnosis of depression or bipolar disorder or had received psychotherapy, antidepressant medicine or hospice care within the previous year.

Characteristics of patients studied included: age, gender, ethnicity, education level, income, and the Elixhauser Comorbidity Index.

Intervention/Instrument: N/A

Outcome Measures: Primary endpoint evaluated was patients who have received follow-up for their new diagnosis of depression within 30 days, as well as type of follow-up (telephone visit, video visit, office visit or home visit).

Results: The absolute number of new diagnoses of depression remained constant during the year preceding the Covid pandemic and the first year of the pandemic (349K vs 359K). Overall, 30-day follow-up of depression fell from 20.5% pre-pandemic to 12.5% during the first year of the pandemic. Despite this decrease telephone visits were used by 10% of patients pre-pandemic but increased to 44% in 2020. Similarly, the proportion of video visit follow-ups increased by 17%.

Conclusions: During the first year of the Covid pandemic, there was a significant decrease in 30 day follow-up of depression. However, there was an increase in use of phone and video consultation.