Care Management Processes Used Less Often for Depression Than for Other Chronic Conditions in US Primary Care Practices

Published in: Health Affairs, v. 35, no. 3, Mar. 2016, p. 394-400

Posted on RAND.org on March 14, 2016

by Tara F. Bishop, Patricia P. Ramsay, Yuhua Bao, Lawrence P. Casalino, Harold Alan Pincus, Stephen M. Shortell

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Research Questions

  1. To what extent are primary care physicians in the United States using care management processes—e.g., disease registries, nurse care managers, quality feedback, patient reminders, and patient education—for patients with depression?
  2. How does this compare to primary care physicians' use of care management processes for other chronic illnesses, such as diabetes?
  3. Which care management processes do primary care physicians use most often for patients with depression?
  4. What types of primary care practices are associated with high rates of use of care management processes for depression?
  5. Has the use of care management processes increased over time?

Primary care physicians play an important role in the diagnosis and management of depression. Yet little is known about their use of care management processes for depression. Using national survey data for the period 2006-13, we assessed the use of five care management processes for depression and other chronic illnesses among primary care practices in the United States. We found significantly less use for depression than for asthma, congestive heart failure, or diabetes in 2012-13. On average, practices used fewer than one care management process for depression, and this level of use has not changed since 2006-07, regardless of practice size. In contrast, use of diabetes care management processes has increased significantly among larger practices. These findings may indicate that US primary care practices are not well equipped to manage depression as a chronic illness, despite the high proportion of depression care they provide. Policies that incentivize depression care management, including additional quality metrics, should be considered.

Key Findings

  • On average, primary care practices in the United States use less than one of five recommended care management processes for patients with depression—patient registries are the most commonly used of the five processes.
  • Primary care physicians are less likely to use care management processes for patients with depression than for patients with other chronic illnesses, such as diabetes, asthma, and congestive heart failure.
  • Large primary care practices use more care management processes—though not for depression—than small practices.
  • There was no significant increase in the use of care management processes for depression over time.

Recommendation

To better equip primary care practices to manage depression as a chronic illness, greater attention needs to be given to developing policies and incentives that will increase the use of care management processes for depression.

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