Transcript Depression is a Primary Care Issue

R
• 63 year old widowed, bible carrying, male truck
driver
• A1c = 9.9% (goal <7%)
• Blood Pressure = 180/100 (goal <140/90)
• Cholesterol LDL = 180 (goal < 100)
• Depression PHQ-9 = 20 (goal < 5)
• Multiple Medications:
– Metformin , Simvastatin ,Glipizide XL
– Fluoxetine
Usual care
• See patient in office
– Address patient major concern (foot pain)
– Maybe adjust one or two chronic disease medicines
• Schedule follow up in 3 months depending on
provider availability
• Repeat
• I experience frustration because he is negatively
impacting my outcomes for Diabetes care
Depression is a Primary Care Issue
• 54% of individuals with a mental health condition are
served in primary care
• 42% of patients with clinical depression are
diagnosed by a primary care physician
• Most individuals prefer to receive their mental health
care within the primary care setting since it is
perceived as less stigmatizing than the traditional
mental health system
Depression is depressing
…the mean life span in depressed
patients is 25 to 30 years shorter than
that of the general population
Depression in Chronic diseases
Care of Mental, Physical, and Substance use Syndromes
The project described was supported by Grant Number 1C1CMS331048 from the Department of Health
and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are
solely the responsibility of the authors and do not necessarily represent the official views of the U.S.
Department of Health and Human Services or any of its agencies. The research presented here was
conducted by the awardee. Findings might or might not be consistent with or confirmed by the
independent evaluation contractor.
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COMPASS Consortium: Ten National Partners
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Goals of COMPASS
Improve
• Depression outcomes
• Diabetes control
• Hypertension control
Increase
• Clinician satisfaction
• Patient satisfaction
Decrease
• Costs
• Unnecessary hospital & ED
use
Expand
•
Workforce roles
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Key Components—Part 1
• A defined care management process
• Systematic case review teams
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I’m a care
manager
Me, too
I’m a
family
physician
I’m a
psychiatrist
The Systematic Case Review Team discusses both the medical
and mental health needs of a patient to build an integrated care
plan to achieve patient goals.
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Key Components—Part 2
•
•
•
•
Care management tracking system
Systematic treatment intensification
Monitoring for potentially preventable events
Routine data reporting & QI processes
Key Drivers of Improvement
• Systematic treatment intensification
• Care management tracking system
• Monitoring for potentially
preventable events
• Routine data reporting and QI
processes
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Patient characteristics
• All had already failed “usual care” in their system
• Insurance mix
–
–
–
–
Commercial: 27%
Medicaid 20%
Medicare 47%
Dual 5%
• Average length of enrollment: 6 months
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Patient characteristics
• Average age: 59.7 years (range 18-99)
• Gender mix: 64.3% female
• Diagnosis
46%-Depression & DM
33%-Depression, DM & HTN
14%-Depression & HTN
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Patient satisfaction with depression care
Baseline
(N=569)
After one year
(N=378)
Unsatisfied or
very unsatisfied
9.5 %
6.4 %
Neutral
22 %
15.3 %
68.6 %
87.9 %
Satisfied or very
satisfied
Clinician satisfaction
Clinician satisfaction with clinic resources
Baseline
(N=709)
One year
(N=689)
Unsatisfied or very
unsatisfied
21.8 %
14.3 %
Neutral
13.3 %
15.1 %
Satisfied or Very
satisfied
65.1%
70.6 %
Clinical Outcomes
Condition
Goals
Outcomes
Depression
Improve control
for 40% of
patients
61%
Showed significant improvement
Diabetes
Improve control
rates by 20%
Improve control
Hypertension
rates by 20%
23%
Absolute improvement in patients
with A1c <8
58%
With uncontrolled hypertension
who achieved measure control
March 2015
Care of Mental, Physical, and Substance use Syndromes
The project described was supported by Grant Number 1C1CMS331048 from the Department of Health
and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are
solely the responsibility of the authors and do not necessarily represent the official views of the U.S.
Department of Health and Human Services or any of its agencies. The research presented here was
conducted by the awardee. Findings might or might not be consistent with or confirmed by the
independent evaluation contractor.
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R a 63 year old widowed, male truck driver
• A1c = 8.7% (goal <8%) (was 9.9%)
–
–
–
–
–
Metformin
Glipizide XL
Pioglitazone
Insulin Glargine
(Tried Exanatide unable to tolerate)
R a 63 year old widowed, male truck driver
• Blood Pressure = 126/78 (goal <140/90) (was
180/90)
– Lisinopril
– HCTZ
• Cholesterol LDL = 96 (goal < 100) (was 180)
• Atorvastatin
R a 67 year old retired, widowed, male
truck driver
• Depression PHQ-9 = 8 (goal < 5) (was 20)
• Venlafaxine XL 225 mg once a day
• Buproprion XL 150 mg once a day
• Tried Fluoxetine up to 80 mg a day
• “Depression and Chronic Diseases: It Is Time for a
Synergistic Mental Health and Primary Care
Approach”
Voinov, B, MD, Richie, W.D., MD and
Bailey, R, MD
Prim Care Companion CNS Disord. 2013; 15(2):
PCC.12r01468