2051. VA Treatment Of Depression: Are Patients Receiving Adequate Follow-up?
Karen L Austin, MPH, Center for Practice Management and Outcomes Research, SMITREC, B Collins, Office of Quality and Performance, VACO, JF McCarthy,
Center for Practice Management and Outcomes Research, SMITREC, M Valenstein,
Center for Practice Management and Outcomes Research, SMITREC
Objectives: Guidelines recommend that patients with new episodes of major depression receive at least 3 follow-up visits and continuous antidepressant treatment during the acute treatment phase. We use performance measures developed with the VA Office of Quality and Performance to examine VA adherence to these recommendations.
Methods: We identified 20,575 VA patients with new episodes of depression in FY02 or first quarter FY03. These patients had received a depression diagnosis and antidepressant prescription, with no depression diagnoses in the previous 120 days and no antidepressant fills in the 90 days preceding the antidepressant start. We assessed rates of adequate follow-up visits (>3 visits in the 12 weeks following diagnosis) and antidepressant medication coverage (>12 of the following 16 weeks). In separate multivariate logistic regression analyses we examine predictors of adequate follow-up.
Results: Only 9% of patients completed >3 follow-up visits and just 34% received adequate antidepressant coverage. Older patients were more likely to receive adequate visit and antidepressant coverage. African Americans and patients with substance abuse or psychiatric co-morbidities were more likely to receive adequate follow-up visits but less likely to receive adequate antidepressant coverage. Follow-up rates varied significantly by geographic region, with southern facilities having the lowest rates.
Conclusions: New performance measures developed with the VA OQP indicate that only a minority of depressed VA patients receive adequate follow-up visits and antidepressant coverage during the acute treatment phase.
Impact: The VA may need to make substantial changes in its treatment processes for new episodes of depression.