Increased follow-up care proves key to helping depressed patients feel better

New data released by two non-profit health care organizations, MN Community Measurement and the Institute for Clinical Systems Improvement (ICSI), indicate that Minnesota providers only slightly improved their quality of care for patients with depression from a year ago, but that new programs that increase clinic contact with the patient demonstrate the potential for much better results moving forward.

A total of 5.8% of patients were in contact with their clinic and in remission - no longer depressed - six months after they were diagnosed with clinical depression and then treated in the 184 primary care and behavioral health clinics reporting their results. This was a 1.2% improvement over results reported by 148 clinics to MN Community Measurement last July. The data is available on MN Community Measurement's Web site,MN HealthScores.

"We knew improving depression care was a very difficult task," said Jim Chase, president of MN Community Measurement "but now we are starting to see that clinics that implement changes to their treatment programs, as is done in the ICSI DIAMOND program for example, have better patient outcomes compared to typical primary care treatment for depression."

Increasing Clinic Contact Makes a Difference

MN Community Measurement noted that since it started collecting data for depression measures in 2008, more clinics have implemented changes to their treatment programs. Increasing a clinic's ongoing contact with the patient, as is done in the ICSI DIAMOND program, for example, shows that such an approach yields superior patient outcomes compared to typical primary care treatment for depression.

The DIAMOND program, now in 83 clinics, uses a team comprised of the primary care provider, a care manager, and a consulting psychiatrist to increase the frequency of contact with the patient, track the patient's progress, implement evidence-based practices faster to patients who are not responding well to treatment, and motivate the patient toward goal setting and self management. It also uses the PHQ-9 questionnaire to identify patients with depression, and tracks patient progress through 12 months using a patient directory.

Of the top 10 performing clinics in the MN Community Measurement report, seven offered the DIAMOND program. The number one performer - Mayo Northwest Clinic, had 35.8% of its patients with depression in remission by six months. A second Mayo clinic, three Family HealthServices Minnesota clinics, and one clinic each from Allina Medical Clinic and HealthPartners Medical Group were also in the top 10, with patient remission rates 2-4 times better than the aggregated 5.8% remission rate for all clinics reporting.

"Prior to the DIAMOND project, appointments with our psychiatrists were often booked out three months ahead. Patients who are depressed can't wait that long for care, feeling miserable. They would often go to the emergency room for help, or get care another way," said Dr. Mark Williams, consulting psychiatrist with Mayo Northwest Clinic.  "Now with DIAMOND we team with a care manager and the primary care physician to treat those patients we can in primary care, and refer those needing other services to behavioral health clinics.

The DIAMOND project is directed at improving care in primary care clinics. Similar strategies to maintain contact between depressed patients and health care providers have been used very effectively by other primary care and behavioral health clinics as well. HealthPartners West Psychiatry and HealthPartners Woodbury Psychiatry, also among the top 10 performers, ask staff psychotherapists and psychiatrists to voluntarily review a registry of patients with depression and contact patients who have not scheduled follow-up appointments. They also have mailed a PHQ-9 survey to patients' homes and asked them to complete and mail it back to their doctor if they're feeling well or call for an appointment if they have symptoms of depression.

"The very nature of depression is such that when you are depressed you lose your normal energy and initiative, as well as your ability to perform necessary tasks," said Dr. Michael Trangle, associate medical director of the behavioral health division of HealthPartners Medical Group. "Depressed patients are much more likely to not schedule follow up appointments or show up for appointments. We try everything we can think of to make it easier for them to share the responsibility for staying in contact with us."

Last summer, MN Community Measurement reported the first results from a first-in-the-nation measure of the outcomes of depression care. Clinics that participate in the measure use a nine-question patient survey called the PHQ-9 to diagnose and assess the progress of patients with depression. The survey asks patients whether they are feeling certain signs and symptoms of depression. Patients who get a score between 10 and 27 are considered clinically depressed. After treatment, if the patients reports a score of five or lower, they are considered no longer depressed, or in remission. New data show that only 4.7% of patients are still in remission a year after their initial diagnosis with depression