Summary

A Clinical Practice Improvement study was conducted at six HMOs throughout the US to determine whether older and younger HMO patients with depression are treated differently with respect to diagnosis, treatment by specialty provider, and pharmacotherapy. Data were collected from 13,000 patients at every encounter for one year. Results show significant differences in treatment of depression for older vs. younger patients.

Primary Objectives

Examine whether older and younger HMO patients with depression are treated differently with respect to diagnosis, treatment by specialty provider, and pharmacotherapy.

Methods

1. 13,000 patients from six HMOs throughout the US were assessed for severity of illness at every encounter for one year, totaling more than 99,000 outpatient visits, 480 emergency department visits, 1,000 hospitalizations, and 240,000 prescriptions.
   

2. Patients had at least one of five diseases (arthritis, asthma, epigastric pain/ulcer, hypertension, and otitis media). In addition, chart diagnoses and pharmacy records were used to identify patients who also had a diagnosis of depression (n = 416) or who had a diagnosis of depression and/or treatment with antidepressant medication (n = 1,286).
   

3. HMO settings had various levels of formulary limitations on drugs to treat the five study diseases.
   

4. Outcome measures were prescription count and cost, office visit count, emergency department count, and hospitalization count.
   

5. Multivariate regression was used to control for other variables, including severity of illness, provider count, age, gender, and time in study.

Results

1. Significant differences in treatment of depression for older vs. younger patients were found.
   

2. Although depression was observed to occur at the same rate for older and younger patient groups, older patients received significantly fewer mental health specialty visits and significantly fewer prescriptions for newer SSRI antidepressants.
   

3. Older patients with depression diagnosis were more likely to be treated with benzodiazepines (49% of older vs. 33% of younger), but were less likely to receive long half-life benzodiazepines.

Impact

Psychotropic medication management is an important target for improving quality of care for elderly patients with depression in HMOs. Decreasing inefficient minor tranquilizer use and increasing use of newer antidepressant medications may lead to improved outcomes for older depressed adults (Intl. J. Psych. in Medicine, 27, 1997:215-231).