Primary care needs more info on behavioral health

Less than half of recognized patient-centered medical homes have a behavioral health clinician on site, according to a study presented in the September October 2014 issue of the Journal of the American Board of Family Medicine. Although the practice models are meant to provide comprehensive care, response to behavioral issues seem to be less well developed than other types of medical care, according to authors.

Sixty-two percent of the 123 responding practices reported using electronic, standardized depression screening and monitoring, however, practices were less likely to screen for substance use than mental health. Among the practices, 54 percent used evidence-based health behavior protocols for mental health and substance use conditions. The most common obstacles reported were lack of reimbursement, time and knowledge.

While depression screening in primary care practices is often viewed as a key prevention tool, clinicians might risk patterns of overprescribing antidepressant medications. In a separate study presented in the Journal of the American Board of Family Medicine, researchers found that brief depression symptom measures, particularly the PHQ-9, may be associated with depression diagnosis and antidepressant prescription among patients unlikely to have major depression.

Among the 545 patients without a practice-administered measure, 10.5 percent had a visit diagnosis of depression; 1.6 percent were recommended and another 3.8 percent prescribed an antidepressant. Among the 50 patients with a practice-administered measure, 20 percent had a visit diagnosis of depression; 12 percent were recommended and another 12 percent were prescribed an antidepressant.