Older patients with depression who are enrolled in health maintenance organizations (HMOs) receive fewer visits with mental health professionals and are more likely to be given tranquilizers rather than antidepressant medication, researchers report.
And, when they are prescribed antidepressants, they are more likely to receive older varieties that have more side effects.
Stephen J. Bartels, MD, MS, of Dartmouth Medical School, Lebanon, NH, and Susan Horn, PhD, and colleagues at The Institute for Clinical Outcomes Research, Salt Lake City, studied health care practice over one year in six cooperating HMOs. More than 9,000 patients were selected who had one or more of the five most common diagnoses in primary care: arthritis, asthma, ear infections, epigastric pain or ulcers, and hypertension.
From this group, 1,286 patients were identified who also were treated for depression. When the treatment received by patients 65 and older was compared with that for patients 18 to 65, the older patients were found to have fewer visits with mental health specialists and to be prescribed benzodiazepines instead of antidepressants.
Writing in the October issue of the International Journal of Psychiatry in Medicine, the researchers note that "treatment of depression for older adults is particularly important in today's rapidly changing health care environment." They say the disparity in treatments may be due to HMO cost containment strategies.
"Research on the consequences of HMO cost-containment suggests that restrictions that successfully decrease utilization in one area may cause increases in others," the authors write. "Monitoring the appropriateness of treatment is central to restructuring health care provision in ways that maximize cost-effectiveness and quality of care. Physically ill older adults with both depression and other medical illnesses are especially likely to be affected by cost-containment due to their heavy utilization of health services. "
The authors suggest that psychotropic medication management is an important target for improving quality of HMO care for depression and that additional research is needed to demonstrate the system-wide cost-effectiveness of safer but more expensive antidepressants for vulnerable elderly patients. The researchers also point out that the difference in treatments between the older and younger groups could result from the fact that older patients make greater use of specialty medical providers and surgical specialists. This, they note, emphasizes the importance of nonpsychiatric physicians as a contact point for mental health treatment and suggests that restricting access to mental health specialists is unlikely to reap significant cost savings in comparison to other specialty providers.
Their findings are in the Journal's October issue as part of the Global Theme Issue on Aging being published simultaneously with 91 other international medical journals to bring attention to the importance of issues on aging. The research was supported in part by the National Institute of Mental Health and the John D. and Catherine T. MacArthur Foundation.
The International Journal of Psychiatry in Medicine is published quarterly by Baywood Publishing Company and covers biopsychosocial aspects of primary care.
Release posted by the Center for the Advancement of Health