Depression management in medical clinics: does healthcare sector make a difference
Department of Quantitative Health Sciences
Medical Subject Headings
Adult; *Ambulatory Care Facilities; Depression; Female; *Health Care Sector; Health Services Research; Humans; Male; Middle Aged; New England; Physician's Practice Patterns; Primary Health Care; *Quality Assurance, Health Care; United States; United States Department of Veterans Affairs
Biostatistics | Epidemiology | Health Services Research
Medical providers often fail to treat depression. We examined whether treatment is more aggressive in a setting with accessible mental health resources, the Veterans Health Administration (VA). VA and non-VA primary care physicians and medical specialists viewed a videotape vignette portraying a patient meeting criteria for major depression and then answered interviewer-administered questions about management. We found that 24% of VA versus 15% of non-VA physicians would initiate guideline-recommended treatment (antidepressants or mental health referral, or both) (P = .09). Among those who identified depression as likely, 42% of VA versus 19% of non-VA physicians would treat (P = .002): 23% versus 3% recommended mental health referral (P < .001) and 21% versus 17% an antidepressant (P = .67). Although many patients with major depression may not receive guideline-recommended management, VA physicians do initiate mental health referral more often than do non-VA physicians. Access to mental health services may prove valuable in the campaign to increase physician adherence to depression clinical guidelines.
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Citation: Am J Med Qual. 2004 Jan-Feb;19(1):28-36. Link to article on publisher's site