Identifying and Managing Depression in Women

BACKGROUND: Depression is a complex disease often occurring with comorbid mental health or medical illnesses. It is highly prevalent and treated most frequently by a primary care physician (PCP). Depression affects the total health status of the patients who have it, and depression patients with comorbidities generally experience worse outcomes. It is also one of the most costly chronic illnesses, as measured by absenteeism and reduced productivity at work, direct medical costs, and suicide-related costs. Despite its high prevalence and being a frequent illness encountered during clinic visits, depression presents many challenges for the PCP in diagnosing and managing the illness and in bringing a patient to full remission. But depression is a highly treatable disorder. With appropriate diagnosis and intervention, depression can be reversed and most patients return to normal functioning. OBJECTIVES: To provide an overview of a case study of a 24-month, managed care, depression care management program that incorporated a bilayered approach to optimize patient outcomes. SUMMARY: Patients being treated for depression by a PCP were assigned a care coach who provided educational and goal-setting training by telephone. Psychiatric medical directors were involved in overseeing the treatment plan and consulted with PCPs to optimize treatment plans. CONCLUSIONS: Initial outcomes of this program indicate that it was successful in improving patient care and also in reducing overall costs associated with a depressed population. Results included a reduction in the average Hamilton Depression Rating Scale from 10.4 to 5.6, a 56% reduction in hospital admissions for depression, and an 18% total reduction in health care costs per member per month.