The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #56818

Carole Upshur, EdD¹, Michael Norton, MSW², Annette Hanson, MD³, and Linda Weinreb, MD¹. (1) 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, (2) Massachusetts Division of Medical Assistance, 600 Washington St., 5th floor, Boston, MA 02111, (3) Office of Clinical Affairs, Massachusetts Division of Medical Assistance, 600 Washington Street, Boston, MA 02111

In the past decade there has been increasing recognition of depression as a major chronic illness affecting 8-10% of the US adult population, and much higher proportions of disadvantaged populations. However, there is widespread evidence that depression frequently remains undiagnosed, and when treated, a majority of patients fail to sustain medications, therapy or self-management activities, resulting in repeat episodes of treatment initiation and high health care utilization. A variety of studies have been undertaken to implement guideline-based identification and treatment of depression in primary care settings, complemented by mental health consultation, physician education, and standardized screening and treatment protocols. While improved medication adherence and clinical outcomes have been documented as part of research interventions of structured treatment of depression in primary care, the challenge is how to implement the same approach across health care delivery systems with enough rigor to produce similar patient outcomes. This paper will report findings based on initial implementation of the Massachusetts Consortium on Depression in Primary Care, a project supported by the Robert Wood Johnson Foundation, that involves the state Medicaid agency, four health plans and two behavioral health carve out organizations that interact with community health centers, outpatient departments, and small group practitioners serving consumers. We will identify the barriers to improving the diagnosis and treatment of Medicaid consumers with major depression, with an emphasis on identification and resolution of structural and financial barriers faced by primary care providers in treating depression and in accessing adequate behavioral health services using a partnership approach.

Learning Objectives:

• At the end of the session, the participant will be able to:
• 1)understand some of the major structural and financial barriers primary care providers serving Medicaid consumers with depression encounter;
• 2)identify some of the policy changes that can be enacted by health plans to improve depression care;
• 3)identify some of the factors that result in a successful partnership across constituency groups to improve patient care

Keywords: Depression, Medicaid

Related Web page: www.mcdpc.org

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.