Improving adherence to HEDIS/EPRP measures for newly prescribed antidepressants in primary care with a depression monitoring program

Ross JT, Mavandadi S, Ingram EP, Witte LM, Eakin AC, Seppelt J, Murphy J, Oslin DW. Improving adherence to HEDIS/EPRP measures for newly prescribed antidepressants in primary care with a depression monitoring program. Paper presented at: VA HSR&D National Meeting; 2007 Feb 22; Arlington, VA.

Objectives: The minimal standard of the HEDIS/EPRP performance measure for monitoring newly initiated pharmacotherapy for major depression requires clinicians to provide a minimum of 3 clinical assessments within an 84 day period after treatment is initiated. Previous research, however, has shown that this is rarely met within primary care (roughly 13%). This investigation sought to evaluate the utility and feasibility of a telephone based depression monitoring program designed to assist primary care providers in delivering guideline adherent depression care. Methods: Primary care patients who were prescribed a new antidepressant were identified from CPRS by the pharmacy casefinder and were enrolled in the Depression Monitoring Program if they were not being followed in specialty mental health care. The monitoring program consisted of an initial baseline assessment and 3 follow-up interviews that monitored depressive symptoms, treatment adherence, and medication side effects. Results: Of the 214 patients identified, 156 (72.9%) received a complete baseline assessment. Of those assessed, 6 (3.8%) were identified as having severe cognitive impairment and 32 (20.5%) were identified as requiring further care in Mental Health/Substance Abuse specialty clinics. Overall, 124 (56%) patients had at least 2 structured assessments which counted toward meeting HEDIS/EPRP standards. Remission of depressive symptoms was significantly related to medication adherence (p = .03) and absence of side effects (p = .003). Implications: The findings show that a telephone based program can be a successful support service in assisting primary care clinics within the VHA to meet the HEDIS/EPRP depression treatment guidelines for recommended follow-up visits. Impacts: Previous research has demonstrated that meeting the HEDIS/EPRP standards is associated with greater improvement of patients’ depressive symptoms. Furthermore, increased adherence to these measures has the potential to result in overall clinical and system improvement in the way that depression is treated in primary care. Nevertheless, although the HEDIS/EPRP standards are minimal, prior evidence has shown that they are rarely met in primary care. Implementation of our depression monitoring program would assist in adherence to HEDIS/EPRP measures and standards, thus improving depression outcomes and overall quality care.