Primary care not helping manage depression

Although primary care doctors frequently see patients with depression, they typically do less to help those patients manage it than they do for patients with other chronic conditions such as diabetes, asthma or congestive heart failure, a recent study found.

That is important because research has found that it can be good for patients’ health when physician practices have procedures in place to identify and provide targeted services to patients with chronic conditions and to encourage patients to get involved in actively managing their own care.

But physicians were less likely to use those “care-management processes” with patients who have depression than with those who had other chronic conditions, according to the study in the March edition of the journal Health Affairs.

The study analyzed data from the three largest national surveys of physician practices to determine the extent to which they employed five care-management processes between 2006 and 2013. The five processes studied were patient education; patient reminders about preventive care; nurse care managers to coordinate care; feedback on care quality to providers; and disease registries that identify patients with chronic conditions, enabling practices to be proactive about their care.

The results were particularly dismal for depression. In the 2012 to 2013 time frame, physician groups on average used fewer than one (0.8) of the care-management processes for their patients with depression, and that level of use hadn’t changed since the 2006 to 2007 period, according to the study. In contrast, practices used 1.7 diabetes care-management processes on average overall with their patients between 2012 and 2013. Among only large practices, the use of diabetes care-management processes grew significantly over time, to 3.2 in 2012-2013.

The use of care-management processes for patients with congestive heart failure and asthma was 1.1, a statistically significant difference compared with their use in patients with depression. Still, Dr. Tara F. Bishop, the lead author of the study and an associate professor in the department of healthcare policy and research at Weill Cornell Medical College in New York City, said those measures were also considered low.

The depression results were not surprising, said Bishop. 

“There’s a growing understanding that depression and mental illness generally are being undermanaged [in primary care settings] and we’re not using the tools that are available,” she said.

It may be that physicians are less comfortable managing psychological illnesses than they are physical ones, but size may also matter, she said. Primary care practices that are part of academic medical centers or integrated healthcare systems may be better equipped to adopt care-management processes, while smaller, independent practices have trouble marshaling the staff and other resources necessary to put comprehensive care-management techniques to use.

Kaiser Health News is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.