Under-treatment of depression exists in the VHA, despite considerable mental health access and generous pharmacy benefits. Certain patient populations may be at higher risk for inadequate depression care. More work is needed to align current practice with best-practice guidelines and to identify optimal ways of using available data sources to monitor depression care quality.

Most older veterans received potentially inappropriate AED therapy. Hence, the standard of care for older patients with epilepsy should be reevaluated, although the vast use of phenytoin in this population suggests that change in practice patterns may be difficult.