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Quality Letter

The Quality Letter for Healthcare Leaders

Lead story researched and written by Vicki Meade

Newsletter published 11 times a year by Capitol Publications, Inc. Alexandria, VA

Excerpt

Identifying and Caring For Depressed Patients: Healthcare Organizations Try New Approaches

Evidence suggests that depressed patients are seriously undertreated. Healthcare organizations arc responding with new models of care, treatment protocols, training and heavier reliance on primary care.


Depression — one of the most common illnesses in our society — affects as many as 15% of men and 24% of women at some point in their lives. At any given time, major depression occurs in 2% to 4% of people in the community and among 5% to 10% of primary care patients. It's an expensive illness — one of the 10 most costly in the United States — resulting in $12 billion in direct medical outlays each year and $31 billion in indirect costs resulting from premature death, job absenteeism and lost productivity. Pain, illness, work problems, family problems and usage of medical services are all higher among depressed patients. A recent study suggests that depressed primary care patients use double to triple the amount of healthcare services as their nondepressed counterparts. Patients with depression have greater mortality rates than average, and depression has been shown to increase the risk of developing such serious disorders as coronary heart disease and diabetes. The good news about depression is that, if detected and treated properly, a complete remission occurs in 80% of cases. But much work still needs to be done to educate health professionals and the public and to develop cost-effective models of care that are geared to today's busy healthcare organizations.

There is strong evidence that people with depression are getting inadequate treatment — and sometimes no treatment at all. In January, The Journal of the American Medical Association published a report from a consensus conference on the undertreatment of depression, organized by the National Depressive and Manic Depressive Association. People with depression are "seriously undertreated," the report says, citing such reasons as social stigma that prevents people from seeking care, limited access to services, poor provider education about depression, lack of time to evaluate and treat depression and prescribing inadequate dosages of antidepressant medications for too short a time.