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American Journal of Medical Quality, Vol. 19, No. 1, 28-36 (2004)
DOI: 10.1177/106286060401900106
© 2004 American College of Medical Quality

Depression Management in Medical Clinics: Does Healthcare Sector Make a Difference?

Susan M. Frayne, MD, MPH

sfrayne{at}stanford.edu

Karen M. Freund, MD, MPH

Women's Health Unit, Evans Department of Medicine, Boston Medical Center and Medicine, Boston University, Boston, Mass

Katherine M. Skinner, PhD

Boston University, Boston, Mass, and Research Associate, Center for Health Quality, Outcomes and Economic Research, VA Medical Center, Bedford, Mass

Arlene S. Ash, PhD

Boston University, Boston, Mass

Mark A. Moskowitz, MD

Medical providers often fail to treat depression. We examined whether treatment is more aggressive in a setting with accessible mental health resources, the Veterans Health Administration (VA). VA and non-VA primary care physicians and medical specialists viewed a videotape vignette portraying a patient meeting criteria for major depression and then answered interviewer-administered questions about management. We found that 24% of VA versus 15% of non-VA physicians would initiate guideline-recommended treatment (antidepressants or mental health referral, or both) (P = .09). Among those who identified depression as likely, 42% of VA versus 19% of non-VA physicians would treat (P = .002): 23% versus 3% recommended mental health referral (P < .001) and 21% versus 17% an antidepressant (P = .67). Although many patients with major depression may not receive guideline-recommended management, VA physicians do initiate mental health referral more often than do non-VA physicians. Access to mental health services may prove valuable in the campaign to increase physician adherence to depression clinical guidelines.

Key Words: Depression • models • organizational • physician's practice patterns • primary health care • quality assurance • health care • veterans


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