Identifying depression in the primary care setting

Depression is the leading cause of disability in the U.S. for ages 15 to 44.3. The impact of depression on physical health can include chronic pain, increased risk of heart disease, exacerbation of chronic conditions, and insomnia.  

Primary care providers (PCPs) are often the first to recognize the signs of depression. In order to confirm or rule out a diagnosis, PCPs should use the PHQ-9 screening tool. For more information regarding the PHQ-9 and to obtain the screening tool in additional languages, please refer to PHQ screener website.
After an initial diagnosis of depression, PCPs may consider starting a patient on an antidepressant medication. When you prescribe an antidepressant, it's critical to talk to your patient about the side effects of these medications, the length of time it may take to start working, and the need for regular follow-up visits with either their PCP or a behavioral health provider. These follow-up visits provide the opportunityto discuss any side effects, address possible concerns around worsening symptoms, and allow for adjustments to the medications to be made.

If you are a PCP, you know that antidepressants are frequently prescribed in the primary care setting. You also know that patients often don't take their medications as prescribed. To learn why patients can be non-adherent with their anti-depressant medications, AllWays Health Partners held feedback forums with members who have a diagnosis of depression. In these forums, we learned that members often stop taking their antidepressants because they aren't feeling better (without an adequate trial and/or dose of medication) or because of their medication's side effects.

To address these findings, we've been working with our behavioral health partner, Optum, on a variety of initiatives to raise awareness about the National Committee for Quality Assurance (NCQA) HEDIS® Antidepressant Medication Management (AMM) measures.  The HEDIS AMM measure specifically focuses on follow-up care for those prescribed antidepressant medication.

What is the HEDIS AMM measure?
After an initial diagnosis of depression and prescription of an antidepressant medication, regular follow-up visits are recommended to support patients with treating their illness to:
- Remain on antidepressant medication for at least 84 days (Effective Acute Phase)
- Continue taking antidepressant medication for at least 180 days (Effective Continuation Phase)

Click here for more information about the HEDIS AMM measure and best practices on how you can help patients improve antidepressant medication adherence.

How to Improve Your Patient's Antidepressant Adherence
What can you do to improve your patients' adherence to their treatment plans? First and foremost, develop rapport and engage your patient collaboratively in the development of their treatment plan.

Educate the patient on important issues that impact adherence, such as:
- When will the medication start working and how will your patient know it is working?
- What it will feel like to be on the medication?
- How long will it take for the medication to work?
- How long should the patient expect to take the medication?
- Why is it important to continue the medication?
- What should the patient do if they have any questions, possible side effects or concerns?
- Reiterate the importance of attending follow-up visits

Patients also benefit from information about common side effects, how long the side effects may last, and how to manage those side effects. This information should be simple and specific.

In addition, some patients benefit from referral to a behavioral health specialist. If you do refer your patient, be sure to coordinate care with the specialist, and follow up with the patient about his/her treatment, particularly regarding medications. As the primary care provider, you are in a powerful position to promote your patient's adherence to treatment.

Additional Resources
HEDIS Tip Sheet (see page 15)
Depression FAQ