Managing Elderly Depression in Primary Care: How a Medicare HMO Measures Up to AHCPR Clinical Practice Guidelines

A secondary data analysis was performed to determine how a Medicare HMO managed elderly depression as compared to depression management guidelines established by the Agency for Health Care Policy and Research (AHCPR). The subjects totaling 1958 ( 28% of the HMO patient population), were selected due to having a medical claims record of a depression diagnosis or a prescription for antidepressants or other psychotropic drugs frequently used for depressive symptoms. Claims records were summarized to produce dichotomous variables for each subject to distinguish those patients who had a specific diagnosis or treatment form those who did not have that same diagnosis or treatment. Diagnosis and treatment variable combinations were used to compare proportions between patient groups and to compare HMO diagnosis/treatment patterns to AHCPR guidelines. Diagnosis and treatment differences were found between primary care physicians and mental health specialists. Pharmacotherapy treatment of depression, in general, was much more consistent with AHCPR guidelines than other reports, but improvements in differential diagnosis of depressive types and employment of optimal treatment protocols for each were indicated.