Article Figures & Data
Figures
- Figure 1.
Depression Care Quality Changes Over Time
Rx = prescription; PC = primary care; CoC = continuity of care; MH = mental health.
Tables
Measure Depression Type* Definition *Depression A = new antidepressant treatment cases; depression B = all depression cases. Effectiveness Acute-phase treatment A Continuation of new antidepressant for 84 d Continuation-phase treatment A Continuation of new antidepressant for 180 d Optimal clinician contact A 3+ visits with mental health codes in 12 wk after new antidepressant Follow-up after mental health hospitalization A, B 1 visit with mental health code within 30 d of discharge Optimal primary care contacts A 3+ primary care visits for depression after starting new antidepressant in primary care No primary care follow-up A 0 primary care visits for depression during 6 months after starting new antidepressant in primary care Mental health collaboration A 1+ visits with mental health clinician after starting new antidepressant in primary care Safety Emergency department visits A, B 1+ emergency department visit in that year Emergency department visit or hospitalization for mental health A, B 1+ emergency department visit or hospitalization with a mental health code Timeliness Prompt follow-up on new medication A Follow-up visit with depression code within 30 d of starting a new antidepressant Prompt medication switch follow-up A, B Follow-up visit with depression code within 30 d of a switch from one antidepressant to another Patient-centeredness Continuity of primary care visits A, B Of those with >1 primary care visit, >50% are with 1 primary care clinician Continuity of mental health primary care visits A, B Of those with >1 depression visit, >50% are with 1 primary care clinician - Table 2.
Descriptive Characteristics of Patients With Depression Using Either Case Definition (Using 1999 as Baseline)
Characteristic 1999 2000 2001 * P <.01 relative to 1999. † P <.05 relative to 1999. ‡ Days patient was taking medication/the total potential days (from claims data), where 1.0 = perfect correspondence. Either case definition, N 6,609 6,988 7,284 Definition A - new antidepressant, n 2,811 2,942 3,041 Definition B - any depression, n 5,803 6,037 6,336 Age in 1998, y 46.0 45.5 44.8* Sex, % male 32.1 31.6 31.8 Charlson score ≥ 1, % 21.4 22.9† 24.3* Diabetes mellitus, % 7.5 8.1 8.9* Coronary heart disease, % 4.9 5.5 6.0* No. of clinic visits, mean 10.8 10.9 10.4* No. of primary care visits, mean 3.5 4.2* 4.4* Any hospitalization, % 19.9 20.7 21.7† Taking an antidepressant, % 86.4 86.3 85.5 Medication possession ratio‡ 0.84 0.84 0.84 Third next available, d 19.4 7.4* 4.5* Continuity of care 0.60 0.61 0.63* Measure 1999% 2000% P Value 2001% P Value Note: 1999 is baseline comparison year for both 2000 and 2001. Effectiveness Acute treatment 64.1 66.2 .09 67.7 .003 Continuation treatment 46.2 48.6 .04 50.8 .000 Optimal clinician contact 22.8 20.5 .02 19.7 .001 Follow-up after mental health hospitalization 65.9 58.2 .09 50.3 .001 Optimal primary care contacts 1.6 2.0 .41 2.0 .34 No primary care follow-up 33.0 20.3 .001 15.4 .001 Mental health collaboration 37.6 34.2 .04 30.7 .001 Safety Emergency department visits 25.6 25.8 .77 27.3 .13 Emergency department visit or hospitalization for mental health 6.5 6.2 .34 6.3 .34 Timeliness Prompt follow-up on new medication 42.2 40.6 .16 40.1 .04 Prompt medication switch follow-up 40.2 40.2 .86 39.3 .19 Patient-centeredness Continuity of primary care visits 67.3 72.7 .000 74.0 <.001 Continuity of mental health primary care visits 87.1 87.7 .43 88.0 .22
The Article in Brief
Effect of Improved Primary Care Access on Quality of Depression Care
Leif I. Solberg, MD , and colleagues
Background Do patients receive better quality care if they have better access to their personal doctors? This study looked at how increased access to primary care doctors affected the quality of care for patients with depression. The study took place in a medical group that implemented �advanced access,� in which patients are offered the opportunity to have an appointment the same day with their clinician of choice.
What This Study Found Better patient access to primary care doctors is associated with improved care of patients with depression. However, improved patient use of antidepressant medication appears to be related to improvement in the ongoing relationship between patient and doctor rather than to more access to doctor visits.
Implications
- Regular follow-up with patients and more attention to integrating primary care and mental health care could improve the quality of depression care.
- Advanced access should be implemented in ways that strengthen the ongoing relationship between patients and doctors.
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