Cost-effectiveness of Systematic Depression Treatment for High Utilizers of General Medical Care

Simon, Gregory E.; Manning, Willard G.; Katzelnick, David J.; Pearson, Steven D.; Henk, Henry J.; Helstad, Cindy P.

doi:10.1001/archpsyc.58.2.181

Cited by 175 publications

(159 citation statements)

References 40 publications

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“…The potential benefit of calculating depression indicators for the population in need is that the resulting indicator could motivate employer purchasers to support cost-effective quality improvement initiatives which modestly increase health care expenditures (Rost, Pyne, Dickinson, & LoSasso. The cost-effectiveness of ongoing management for primary care major depression, 2005) (Schoenbaum et al, 2001;Lave, Frank, Schulberg, & Kamlet, 1998;Simon et al, 2001). …”

Section: Discussionmentioning

confidence: 99%

Clinical Improvement Associated with Conformance to HEDIS-Based Depression Care

Rost

Dickinson

Fortney

et al. 2005

Ment Health Serv Res

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Background: Employers recently requested a valid metric of depression treatment quality. Such an indicator needs to measure the proportion of the population in need who receive high-quality care, and to predict clinical improvement. Methods: We constructed an administrative database indicator derived from HEDIS criteria for antidepressant medication management, and tested it in 230 employed patients in five health plans. Results: Indicator rates were 7.0% in the population in need. Conformance to indicator criteria in this population was associated with 23.0% improvement in depression severity over 1 year (p = .02). Conclusions: Administrative database indicators that predict clinical improvement are a very rare accomplishment. Existing depression indicators may need to be calculated for the population in need to provide a valid metric for employer purchasers.

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Section: Discussionmentioning

confidence: 99%

Clinical Improvement Associated with Conformance to HEDIS-Based Depression Care

Rost

Dickinson

Fortney

et al. 2005

Ment Health Serv Res

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“…8 Only one study examined frequent attendance over 2 years; 10,11 all others included 1-year frequent attenders. [24][25][26] Although none of the studies found evidence that it is possible to influence healthcare utilisation by frequent attenders, the one that included frequent attenders over 2 years did find evidence that treatment of major depressive disorder in a subgroup of depressed frequent attenders improved their symptoms and quality of life.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…8 No study showed convincing evidence that an intervention improves quality of life or morbidity of frequent-attending primary care patients, although an effect might exist in a subgroup of depressed frequent attenders. [9][10][11] For this subgroup, one trial concluded that, in the year following the intervention, patients in the intervention group had a mean of 47 more depression-free days (5% confidence interval [CI] = 27 to 68) than patients with depression who received no intervention. 11 There is no evidence that it is possible to influence healthcare utilisation of frequent attenders.…”

Section: Introductionmentioning

confidence: 99%

Predictability of persistent frequent attendance: a historic 3-year cohort study

Smits¹,

Brouwer²,

Weert³

et al. 2009

Br J Gen Pract

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Few patients who attend GP consultations frequently continue to do so long term. While transient frequent attendance may be readily explicable, persistent frequent attendance often is not. It increases GPs' workload while reducing work satisfaction. It is neither reasonable, nor efficient to target diagnostic assessment and intervention at transient frequent attenders. AimTo develop a prediction rule for selecting persistent frequent attenders, using readily available information from GPs' electronic medical records. Design of studyA historic 3-year cohort study. MethodData of 28 860 adult patients from 2003 to 2005 were examined. Frequent attenders were patients whose attendance rate ranked in the (age-and sex-adjusted) top 10% during 1 year (1-year frequent attenders) or 3 years (persistent frequent attenders). Bootstrapped multivariable logistic regression analysis was used to determine which predictors contained information on persistent frequent attendance. ResultsOf 3045 1-year frequent attenders, 470 (15.4%) became persistent frequent attenders. The prediction rule could update this prior probability to 3.3% (lowest value) or 43.3% (highest value). However, the 10th and 90th centiles of the posterior probability distribution were 7.4% and 26.3% respectively, indicating that the model performs modestly. The area under the receiver operating characteristic curve was 0.67 (95% confidence limits 0.64 and 0.69). ConclusionAmong 1-year frequent attenders, six out of seven are transient frequent attenders. With the present indicators, the rule developed performs modestly in selecting those more likely to become persistent frequent attenders.

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“…15 The US Preventive Services Task Force "recommends screening adults for depression in clinical practices that have systems in place to assure accurate diagnosis, effective treatment, and follow-up" with a grade B recommendation, 16 as such systems have been demonstrated to improve health status and, in some instances, to reduce health care costs. [17][18][19][20] There is a remarkable paucity of information about patients' understanding of depression and its treatment options, and the role patients play in choosing treatment options. The very limited evidence available suggests quite modest benefits of patient education materials for depression in isolation from more comprehensive interventions.…”

mentioning

confidence: 99%

A Qualitative Study of Depression in Primary Care: Missed Opportunities for Diagnosis and Education

Saver¹,

Van-Nguyen²,

Keppel³

et al. 2007

The Journal of the American Board of Family Medicine

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Purpose: Depression is one of the most commonly encountered chronic conditions in primary care, yet it remains substantially underdiagnosed and undertreated. We sought to gain a better understanding of barriers to diagnosis of and entering treatment for depression in primary care.Methods: We conducted and analyzed interviews with 15 subjects currently being treated for depression recruited from primary care clinics in an academic medical center and an academic public hospital. We asked about experiences with being diagnosed with depression and starting treatment, focusing on barriers to diagnosis, subject understanding of depression, and information issues related to treatment decisions.Results: Subjects reported many visits to primary care practitioners without the question of depression being raised. The majority had recurrent depression. Many reported that they did not receive enough information about depression and its treatment options. In the majority of cases, practitioners decided the course of treatment with little input from the patients.Conclusions

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Cost-effectiveness of Systematic Depression Treatment for High Utilizers of General Medical Care

Abstract: Among high utilizers of medical care, systematic identification and treatment of depression produce significant and sustained improvements in clinical outcomes as well as significant increases in health services costs.

Cited by 175 publications

References 40 publications

Clinical Improvement Associated with Conformance to HEDIS-Based Depression Care

Clinical Improvement Associated with Conformance to HEDIS-Based Depression Care

Predictability of persistent frequent attendance: a historic 3-year cohort study

A Qualitative Study of Depression in Primary Care: Missed Opportunities for Diagnosis and Education

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