The 130th Annual Meeting of APHA

Abstract #45431

Carole Upshur, EdD, Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Ave. North, Worcester, MA 01655, 508-334-7267, carole.upshur@umassmed.edu and Michael Norton, MSW, Massachusetts Division of Medical Assistance, 600 Washington St., 5th floor, Boston, MA 02111.

Depression affects almost 10% of American adults at any one time and yet goes under-diagnosed and untreated. Some research suggests that patients with depression are high utilizers of health care services because treatment of medical symptoms does not result in successful resolution of their problems. Depression also accompanies other chronic conditions such as chronic back pain, diabetes or arthritis and complicates management of these diseases. Many adults with depression avoid seeking behavioral health services due to stigma and depend on their primary care doctor for assistance. However, studies have shown that patients treated for depression in primary care often do not receive appropriate prescriptions, lack educational materials or support services, and there are difficulties in coordination and consultation with behavioral health specialists. Managed care systems which make physicians at risk for costs or limit access to specialty care such as behavioral health may exacerbate these problems. The growing costs of prescriptions for antidepressants alone have significant impact on health care resources, leading to calls to make sure better systems of care are in place to assure appropriate treatment protocols are followed and patients achieve improvement in symptoms. This paper will discuss a planning process in a large state Medicaid program with a variety of managed care contracts to identify barriers and incentives to appropriate depression treatment in primary care and to create consensus practice guidelines across several health plans and health maintenance organizations to deliver consistent, high quality depression management to a population of over 300,000 publicly insured adults.

Learning Objectives: At the conclusion of the session, participants will be able to

• Identify clinical, organizational and economic incentives and barriers to quality treatment of depression in primary care.
• State appropriate outcomes for quality improvement.
• Identify techniques to manage complex partnerships and change health delivery practice for publicly insured consumers.

Keywords: Depression, Health Care Quality

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.