Sept. 5, 2007 – 4:33 p.m.
Most patients with depression who receive treatment from primary care physicians do not receive care consistent with quality standards, according to a new RAND Corporation study.
While most primary care physicians did a good job of diagnosing and beginning treatment for depression, and followed specific treatment guidelines more than 70 percent of the time, the primary care doctors did a poor job of following up with patients, researchers found. Fewer than half of the patients in the study completed the minimal course of treatments for either antidepressant drugs or psychotherapy, and only slightly more than half the depressed patients who were not treated were monitored closely, according to a RAND news release.
The lowest quality of care occurred among patients who exhibited the most serious symptoms, including patients who showed evidence of suicide or substance abuse. The study found that among patients who had a previous suicide attempt, just 35 percent were referred to a mental health specialist over the next six months, according to the study, which was published in the September edition of the Annals of Internal Medicine.
Physicians had high rates of adherence to just a 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 RAND report.
“These findings are important for patients since most cases of depression are diagnosed and treated in primary care settings,” said the study’s senior author, Lisa V. Rubenstein, who is also a senior scientist at RAND, a nonprofit research organization. “Right now, primary care physicians don’t have the tools necessary to decide which patients to treat and which to refer to specialized mental health care.”
The RAND study, billed as one of the first to assess primary care providers’ adherence to a comprehensive set of treatment guidelines for depression, examined the experiences of 1,131 patients with depression who were treated in 45 primary care practices across 13 states. The study sites ranged from small private practices to large managed care sites, and about 10 percent of the study’s patients were treated by the Department of Veterans’ Affairs medical 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. Patients who received better-quality care reported fewer symptoms of depression up to two years after the start of treatment.